Individual provider Active NPI

Nathan Hundley, M.D.

  • Emergency Medicine Physician
  • Carrollton, GA
National Provider Identifier
1073908794
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
80002 Issued in GA
Practice address
705 Dixie St
Carrollton, GA 30117
Phone
(770) 812-9597
NPI assigned
Mar 31, 2015
Last updated
Jul 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 80002 GA Primary

Addresses

Primary practice location

705 Dixie St
Carrollton, GA 30117

Mailing address

705 Dixie St
Carrollton, GA 30117-3818
Phone (770) 812-9597

Other practice location 1

1 Medical Center Drive
Room 4601
Morgantown, WV 26506-9149
Phone (304) 293-7215

Other practice location 2

601 Dallas Hwy
Villa Rica, GA 30180-1202
Phone (770) 812-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180814000022 GA Practitioner - Emergency Medicine 6507168119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Alabama School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carrollton Emergency Physicians PCGroup PAC ID 7416860010, 34 clinicians

Practice addresses (Care Compare)

705 Dixie St
Carrollton, GA 30117-3818
Phone (770) 812-9666

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
80002GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carrollton Emergency Physicians, PC Emergency Medicine CurrentSince Jul 16, 2018 Accepting new patients

Locations

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

601 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 456-3000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1073908794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-812-9597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "770-812-9597"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Drive",
            "address_2": "Room 4601",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265069149",
            "country_code": "US",
            "telephone_number": "304-293-7215",
            "fax_number": "304-293-6702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Dallas Hwy",
            "address_purpose": "LOCATION",
            "city": "Villa Rica",
            "state": "GA",
            "postal_code": "301801202",
            "country_code": "US",
            "telephone_number": "770-812-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUNDLEY",
        "first_name": "NATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-31",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "80002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.