Organization Active NPI

The Raisig Clinic and Wellness Center

  • Family Medicine Physician
  • Ellijay, GA
National Provider Identifier
1063695724
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
055290 Issued in GA
Legal business name
THE RAISIG CLINIC AND WELLNESS CENTER
Practice address
60 Highland CT Ste 101
Ellijay, GA 30540-6773
Phone
(706) 698-3627
Fax
(706) 698-3630
NPI assigned
Dec 17, 2007
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William George RaisigNPI 1184614240
Title
Provider
Phone
(706) 698-3627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000494 GA
Family Medicine Physician 207Q00000X 055290 GA Primary

Addresses

Primary practice location

60 Highland CT Ste 101
Ellijay, GA 30540-6773

Mailing address

60 Highland CT Ste 101
Ellijay, GA 30540-6773
Phone (706) 698-3627

Other identifiers 1

IdentifierTypeStateIssuer
DD7615OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041104000343 GA Part B Supplier - Clinic/Group Practice 5496718108 Receives reassigned benefits from 7 practitioners
Practice locations: Ellijay, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1034611Raisig Clinic & Wellness Center, the60 Highland CT, Suite 101, Ellijay, GA 30540Certificate of waiverMar 19, 2028

National Provider Directory

National Provider Directory

Locations

60 Highland Ct
Ellijay, GA 30540
Phone (706) 698-3627

64 Call Wright Rd
Ellijay, GA 30540
Phone (706) 699-3627

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1063695724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 HIGHLAND CT STE 101",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305406773",
            "telephone_number": "706-698-3627",
            "fax_number": "706-698-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 HIGHLAND CT STE 101",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305406773",
            "telephone_number": "706-698-3627",
            "fax_number": "706-698-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RAISIG CLINIC AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "RAISIG",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "706-698-3627"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "000494",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "055290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD7615",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.