Active NPI
John Clayton Church, MD
- Diagnostic Radiology Physician
- Dalton, GA
National Provider Identifier
1194701649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 023575
- Practice address
- 1502 N Thornton Ave
Dalton, GA 30720-3064 - Phone
- (706) 278-9729
- Fax
- (706) 226-9378
- NPI assigned
- Dec 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 023575 | GA | Primary |
Addresses
Primary practice location
1502 N Thornton Ave
Dalton, GA 30720-3064
Mailing address
PO Box 1207
Dalton, GA 30722-1207
Phone (706) 278-9729
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00248245F | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023575 | GA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1194701649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1207",
"city": "DALTON",
"state": "GA",
"postal_code": "307221207",
"telephone_number": "706-278-9729",
"fax_number": "706-226-9378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1502 N THORNTON AVE",
"city": "DALTON",
"state": "GA",
"postal_code": "307203064",
"telephone_number": "706-278-9729",
"fax_number": "706-226-9378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHURCH",
"first_name": "JOHN",
"middle_name": "CLAYTON",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-16",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "GA",
"license": "023575",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00248245F",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}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 Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.