NPIMap

Organization Active NPI

Delta Family Clinic South P.C

Doing business as Delta Family Clinic

  • Adult Mental Health Clinic/Center
  • Flint, MI
National Provider Identifier
1255509832
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
250262 Issued in MI
Legal business name
DELTA FAMILY CLINIC SOUTH P.C
Doing business as
Delta Family Clinic
Practice address
1309 S Linden Rd Ste C
Flint, MI 48532
Phone
(810) 630-1152
Fax
(810) 630-9107
NPI assigned
Feb 15, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Gerard R Williams, PHD LPNPI 1821158817
Title
Owner
Phone
(810) 630-1152

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 250262 MI Primary

Addresses

Primary practice location

1309 S Linden Rd Ste C
Flint, MI 48532

Mailing address

1309 S. Linden Rd.
Suite C
Flint, MI 48532
Phone (810) 630-1152

Other names 1

  • Delta Family Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100324000460 MI Part B Supplier - Clinic/Group Practice 5496880866 Receives reassigned benefits from 11 practitioners
Practice locations: Flint, MI

National Provider Directory

National Provider Directory
Tax ID family
Delta Family Clinic South PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1309 S Linden Rd
Ste C
Flint, MI 48532
Phone (810) 626-5191

4413 Corunna Rd
Flint, MI 48532
Phone (810) 630-1152

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1255509832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 S. LINDEN RD.",
            "address_2": "SUITE C",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-630-1152",
            "fax_number": "810-630-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 S LINDEN RD STE C",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-630-1152",
            "fax_number": "810-630-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA FAMILY CLINIC SOUTH P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "GERARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-630-1152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD LP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MI",
            "license": "250262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.