NPIMap

Organization Active NPI

Evernorth Direct Health LLC

  • Non-Pharmacy Dispensing Site
  • Chatsworth, GA
National Provider Identifier
1134412737
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
002396 Issued in GA
Legal business name
EVERNORTH DIRECT HEALTH LLC
Practice address
531 Duvall Rd
Chatsworth, GA 30705-2087
Phone
(706) 422-6104
NPI assigned
May 16, 2011
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 002396 GA Primary

Addresses

Primary practice location

531 Duvall Rd
Chatsworth, GA 30705-2087

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • MOHAWK HEALTHY LIFE CENTER - MILES/DVD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Direct Health LLC102 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Organizations with this tax ID in the same state 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1134412737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 DUVALL RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307052087",
            "telephone_number": "706-422-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2011-05-16",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "GA",
            "license": "002396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOHAWK HEALTHY LIFE CENTER - MILES/DVD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOHAWK HEALTHY LIFE CENTER - MILES/DVD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.