NPIMap

Organization Active NPI

Premise Health of Georgia Medical, P.C.

  • Multi-Specialty Clinic/Center
  • Dalton, GA
National Provider Identifier
1174154496
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF GEORGIA MEDICAL, P.C.
Doing business as
Shaw Family Health Center Plant WD
Practice address
2305 Abutment Rd
Dalton, GA 30721-4881
Phone
(706) 532-2588
Fax
(706) 532-2589
NPI assigned
Jan 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Dr. Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2305 Abutment Rd
Dalton, GA 30721-4881

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Shaw Family Health Center Plant WD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Georgia Medical PC50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

Locations

2305 Abutment Rd
Dalton, GA 30721
Phone (706) 532-2588

NPI Registry JSON

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1174154496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 ABUTMENT RD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307214881",
            "telephone_number": "706-532-2588",
            "fax_number": "706-532-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF GEORGIA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-27",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shaw Family Health Center Plant WD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shaw Family Health Center Plant WD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.