Family Practice of Habersham PC
Organization Active NPI Primary Care Clinic/Center · Demorest, GA
NPI 1124154794 · NPPES record last updated Dec 16, 2008
Key facts
- NPI
- 1124154794
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 032741 (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
- Organization subpart
- No
Authorized official
- Name
- Ms. Beverly C Carter
- Title
- Manager
- Phone
- (706) 754-1252
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 8
-
John Timothy Cope, M.D.
-
Alma P. Hilton, N.P.
-
Katie Ann Kastner, FNP-C
-
Chester Riley Baker, NP RN CS
-
Andrea J Fuller, RN,FNP
-
Shannon G Shuler, MS,FNP,CEN
-
Lerryn U Crocker, ADN BSN MSN FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Family Practice of Habe
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 032741 | GA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRP3078 | Other | GA | MEDICARE GRP # |
Other names
- Habersham Primary Care
Other providers in Demorest, GA
- Norma J Engesser
- Joshua Estep
- Megan Kleinert Fairbairn
- Family Care Clayton, LLC
- Family Practice of Habersham PC
- Tammy Danielle Farmer
- Tina Nicole Feldman
- Mark H. Ferdos
- Tracy A Ferguson
- Sloan Fletcher
All providers in Demorest, GA · Primary Care Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.