NPIMap

Organization Active NPI

Department of Behavioral Health & Developmental Disabilities, Ga

Doing business as Southwest Community Clinic

  • Neurology Physician
  • Thomasville, GA
National Provider Identifier
1174942684
Registry record updated Apr 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
51452 Issued in GA
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES, GA
Doing business as
Southwest Community Clinic
Practice address
400 S Pinetree Blvd
Thomasville, GA 31792-7128
Phone
(229) 227-2990
Fax
(229) 225-4052
NPI assigned
Apr 11, 2014
Last updated
Apr 11, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITITES, GAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2014

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

Authorized official

Name
Dr. Holly M Crowley, MDNPI 1629045398
Title
Medical Director
Phone
(229) 227-2990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 51452 GA Primary
General Practice Physician 208D00000X 30647 GA

Addresses

Primary practice location

400 S Pinetree Blvd
Thomasville, GA 31792-7128

Mailing address

400 S Pinetree Blvd
Thomasville, GA 31792-7128
Phone (229) 227-2990

Other names 1

  • Southwest Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090825000435 GA Part B Supplier - Clinic/Group Practice 7416002506 Receives reassigned benefits from 178 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Augusta, GA; Columbus, GA; Decatur, GA; Milledgeville, GA; Rome, GA; Savannah, GA; Thomasville, GA

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 organizations share this tax ID, including this one
Part of
Department of Behavioral Health Developmental Disabilities Ga

Organizations with this tax ID in the same state 21

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

View all 21

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

620 Broad St
Milledgeville, GA 31062
Phone (478) 445-4128

Practitioners & affiliated clinicians

Practitioners 171

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 171

NPI Registry JSON

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

{
    "created_epoch": "1397174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397174400000",
    "number": "1174942684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S PINETREE BLVD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317927128",
            "telephone_number": "229-227-2990",
            "fax_number": "229-225-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S PINETREE BLVD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317927128",
            "telephone_number": "229-227-2990",
            "fax_number": "229-225-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES, GA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITITES, GA",
        "enumeration_date": "2014-04-11",
        "last_updated": "2014-04-11",
        "status": "A",
        "authorized_official_last_name": "CROWLEY",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "229-227-2990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "51452",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "30647",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.