NPIMap

Organization Active NPI

Jeff Davis Urgent Care

  • Family Medicine Physician
  • Hazlehurst, GA
National Provider Identifier
1134535305
Registry record updated Jul 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
068251 Issued in GA
Legal business name
JEFF DAVIS URGENT CARE
Practice address
22 Cross St
Hazlehurst, GA 31539-6426
Phone
(912) 375-4484
Fax
(912) 375-4881
NPI assigned
Jul 8, 2014
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2014

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

Authorized official

Name
Cathy Cason
Title
Cfo
Phone
(912) 375-7781

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 068251 GA Primary
Urgent Care Clinic/Center 261QU0200X GA

Addresses

Primary practice location

22 Cross St
Hazlehurst, GA 31539-6426

Mailing address

PO Box 1690
Hazlehurst, GA 31539-1690
Phone (912) 375-4484

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000404 GA Part B Supplier - Clinic/Group Practice 4981692472 Receives reassigned benefits from 30 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hazlehurst, GA; MC Rae Helena, GA

Other NPIs on the same Medicare enrollment 8

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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2082878Jeff Davis Urgent Care22 Cross Street, Hazlehurst, GA 31539Certificate of waiverAug 24, 2026

National Provider Directory

National Provider Directory
Part of
Hospital Auth of Jeff D

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404777600000",
    "number": "1134535305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1690",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315391690",
            "telephone_number": "912-375-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 CROSS ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315396426",
            "telephone_number": "912-375-4484",
            "fax_number": "912-375-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFF DAVIS URGENT CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA",
        "enumeration_date": "2014-07-08",
        "last_updated": "2014-07-08",
        "status": "A",
        "authorized_official_last_name": "CASON",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-375-7781"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "068251",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 8, 2014; 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.