NPIMap

Organization Active NPI

Family Practice of Habersham PC

  • Primary Care Clinic/Center
  • Demorest, GA
National Provider Identifier
1124154794
Registry record updated Dec 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
032741 Issued in GA
Legal business name
FAMILY PRACTICE OF HABERSHAM PC
Practice address
590 Historic Hwy 441 N
Demorest, GA 30535-1779
Phone
(706) 754-5511
Fax
(706) 754-5577
NPI assigned
Feb 26, 2007
Last updated
Dec 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2008

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

Authorized official

Name
Ms. Beverly C Carter
Title
Manager
Phone
(706) 754-1252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 032741 GA Primary

Addresses

Primary practice location

590 Historic Hwy 441 N
Demorest, GA 30535-1779

Mailing address

PO Box 1779
Demorest, GA 30535-1779
Phone (706) 754-5511

Other names 1

  • Habersham Primary Care Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050818000013 GA Part B Supplier - Clinic/Group Practice 6608806765 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demorest, GA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
J Terry Greene MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

590 441 Historic Hwy N
Demorest, GA 30535
Phone (706) 754-2155

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": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229385600000",
    "number": "1124154794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1779",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "305351779",
            "telephone_number": "706-754-5511",
            "fax_number": "706-754-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 HISTORIC HWY 441 N",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "305351779",
            "telephone_number": "706-754-5511",
            "fax_number": "706-754-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE OF HABERSHAM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-12-16",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-754-1252",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "032741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Habersham Primary Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Demorest, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; 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.