NPIMap

Organization Active NPI

Georgia CVS Pharmacy LLC

  • Pharmacy
  • Hazlehurst, GA
National Provider Identifier
1124179080
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHRE004803 Issued in GA
Legal business name
GEORGIA CVS PHARMACY LLC
Practice address
92 S Tallahassee St
Hazlehurst, GA 31539-6157
Phone
(912) 375-7729
NPI assigned
Jan 16, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Susan Colbert
Title
Director, Payer Relations
Phone
(401) 770-2751

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #0457192 S Tallahassee St, Hazlehurst, GA 31539-6157(912) 375-7729 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Does not accept assignmentParticipating since Dec 24, 2024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100209000543 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8123161429 This NPI is an additional NPI on the enrollment
O20110503000696 GA DME Supplier - Pharmacy 8123161429 Practice locations: Hazlehurst, GA

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 06861290 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PHRE004803 GA
Pharmacy 333600000X PHRE004803 GA Primary
Community/Retail Pharmacy 3336C0003X GA

Addresses

NPPES NPI Registry

Primary practice location

92 S Tallahassee St
Hazlehurst, GA 31539-6157

Mailing address

1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
000111515AMedicaidGA

Other names 1

NPPES NPI Registry
  • CVS Pharmacy # 04571 Doing business as

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 17, 2023.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1124179080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500",
            "fax_number": "401-770-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 S TALLAHASSEE ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315396157",
            "telephone_number": "912-375-7729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "PHRE004803",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE004803",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000111515A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy # 04571",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS Pharmacy # 04571",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazlehurst, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.