NPIMap

Organization Active NPI

Palmetto Health Council Inc

Doing business as YourTown Health

  • Federally Qualified Health Center (FQHC)
  • Senoia, GA
National Provider Identifier
1235517343
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
H800040 Issued in GA
Legal business name
PALMETTO HEALTH COUNCIL INC
Doing business as
YourTown Health
Practice address
48 Main St
Suite 3a
Senoia, GA 30276-1895
Phone
(678) 723-0400
Fax
(770) 599-9779
NPI assigned
May 8, 2015
Last updated
May 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Dr. Tara Brown, DMD
Title
Chief Executive Officer
Phone
(404) 929-8824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X H800040 GA Primary

Addresses

Primary practice location

48 Main St
Suite 3a
Senoia, GA 30276-1895

Mailing address

643 Main St
Palmetto, GA 30268-1138
Phone (404) 929-8824

Other identifiers 2

IdentifierTypeStateIssuer
111009OtherGAMEDICARE PIN
003162752AMedicaidGA

Other names 1

  • YourTown Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150630002532 GA Part A Provider - Federally Qualified Health Center (FQHC) 3476586629 Practice locations: Senoia, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235517343. Details of each certification follow.

Federally qualified health center certification: CCN 111009

Legal name
PALMETTO HEALTH COUNCIL INC
Doing business as
YOURTOWN HEALTH - SENOIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2015
Last certification
Jun 30, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 3, 1978 in GA
Enrollment address
48 Main St 3a
Senoia, GA 30276-1895

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
11D2104022Palmetto Health Council, Inc Dba Yourtown Health48 Main Street, Suite 3a, Senoia, GA 30276Certificate of waiverOct 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Palmetto Health Council Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tara L Brown Individual Corporate OfficerCeo Dec 20, 2020
W-2 Managing EmployeeCeo Dec 20, 2020
Loretta M North Individual Corporate DirectorBoard Member Oct 1, 2011
Valerie Sutton Individual Corporate Director Aug 31, 2021
Patsy S Page Individual Corporate DirectorBoard Member Oct 1, 2010
Aundra Hayes Individual Corporate DirectorBoard Member Dec 10, 2024
Pat Ackey Individual Corporate Director Oct 14, 2017
Ramses Jimenez Individual Corporate DirectorBoard Member Dec 10, 2024
Calvin C Ruffin Individual Corporate DirectorBoard Member Oct 1, 2011
Timothy Humble Individual Corporate DirectorBoard Member Dec 10, 2024
Carlos Montano Individual Corporate Director Jul 31, 2018

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Medical CenterWarm Springs, GA, CCN 111923 Federally qualified health center Operational/Managerial Control Nov 29, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1235517343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 MAIN ST",
            "city": "PALMETTO",
            "state": "GA",
            "postal_code": "302681138",
            "telephone_number": "404-929-8824",
            "fax_number": "404-929-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 MAIN ST",
            "address_2": "SUITE 3A",
            "city": "SENOIA",
            "state": "GA",
            "postal_code": "302761895",
            "telephone_number": "678-723-0400",
            "fax_number": "770-599-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "404-929-8824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": "H800040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "111009",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003162752A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YourTown Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Senoia, GA

Sources for this page

Verify at the official NPI Registry.