NPIMap

Organization Active NPI

Clinica Santa Maria LLC

  • Health Service Clinic/Center
  • Acworth, GA
National Provider Identifier
1255600565
Registry record updated Jun 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
LC20110001409 Issued in GA
Legal business name
CLINICA SANTA MARIA LLC
Practice address
6158 Highway 92 Ste 101
Acworth, GA 30102-2332
Phone
(770) 928-8450
Fax
(770) 928-8452
NPI assigned
Dec 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2012

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

Authorized official

Name
Mr. Antonio Mendoza
Title
Clinic Manager
Phone
(770) 928-8450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X LC20110001409 GA Primary

Addresses

Primary practice location

6158 Highway 92 Ste 101
Acworth, GA 30102-2332

Mailing address

6158 Highway 92 Ste 101
Acworth, GA 30102-2332
Phone (770) 928-8450

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1255600565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6158 HIGHWAY 92 STE 101",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301022332",
            "telephone_number": "770-928-8450",
            "fax_number": "770-928-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6158 HIGHWAY 92 STE 101",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301022332",
            "telephone_number": "770-928-8450",
            "fax_number": "770-928-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA SANTA MARIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "770-928-8450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "LC20110001409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.