Organization Active NPI

Covington One Medical,LLC

  • Internal Medicine Physician
  • Covington, GA
National Provider Identifier
1174732747
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COVINGTON ONE MEDICAL,LLC
Practice address
1065 Access Rd Ste B
Covington, GA 30014-6815
Phone
(707) 385-0045
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Chanel Y Huang
Title
Authorization Officer
Phone
(770) 385-0045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1065 Access Rd Ste B
Covington, GA 30014-6815

Mailing address

PO Box 1277
Covington, GA 30015-1277
Phone (678) 644-6740

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
11D0969885Covington One Medical, LLC1065 Access Road, Suite D, Covington, GA 30014Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory

Locations

1065 Access Rd
#B
Covington, GA 30014
Phone (707) 385-0045

1065 Access Rd
Ste D
Covington, GA 30014

5239 Highway 278 NE
Covington, GA 30014
Phone (678) 660-5106

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1174732747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1277",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300151277",
            "telephone_number": "678-644-6740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 ACCESS RD STE B",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300146815",
            "telephone_number": "707-385-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON ONE MEDICAL,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "HUANG",
        "authorized_official_first_name": "CHANEL",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "AUTHORIZATION OFFICER",
        "authorized_official_telephone_number": "770-385-0045"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.