NPIMap

Organization Active NPI

C-Worth Family Walk-in Clinic, LLC

  • Health Maintenance Organization
  • Chatsworth, GA
National Provider Identifier
1093014532
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
RN115578NP Issued in GA
Legal business name
C-WORTH FAMILY WALK-IN CLINIC, LLC
Practice address
2976 Highway 76
Suite B & C
Chatsworth, GA 30705-6981
Phone
(423) 339-2320
Fax
(423) 339-2321
NPI assigned
Mar 23, 2011
Last updated
Mar 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Mr. Kelly Elliott, NPNPI 1497798532
Title
Owner
Phone
(423) 339-2321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X RN115578NP GA Primary

Addresses

Primary practice location

2976 Highway 76
Suite B & C
Chatsworth, GA 30705-6981

Mailing address

2976 Highway 76
Suite B & C
Chatsworth, GA 30705-6981
Phone (423) 339-2320

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251107000506 GA Part B Supplier - Clinic/Group Practice 5597255547 Receives reassigned benefits from 1 practitioner
Practice locations: Chatsworth, GA

National Provider Directory

National Provider Directory
Tax ID family
C-Worth Family Walk-in Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2976 Highway 76
Ste B
Chatsworth, GA 30705
Phone (706) 517-0656

Practitioners & affiliated clinicians

Practitioners 2

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": "1300838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1093014532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 HIGHWAY 76",
            "address_2": "SUITE B & C",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307056981",
            "telephone_number": "423-339-2320",
            "fax_number": "423-339-2321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 HIGHWAY 76",
            "address_2": "SUITE B & C",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307056981",
            "telephone_number": "423-339-2320",
            "fax_number": "423-339-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C-WORTH FAMILY WALK-IN CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-23",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-339-2321",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "GA",
            "license": "RN115578NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatsworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.