NPIMap

Organization Active NPI

La Clinique LLC

  • Family Medicine Physician
  • Dalton, GA
National Provider Identifier
1285401901
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LA CLINIQUE LLC
Practice address
1240 N Thornton Ave
Dalton, GA 30720-3605
Phone
(706) 229-9313
Fax
(706) 229-9388
NPI assigned
Dec 4, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Authorized official

Name
Ramses Vega-Casasnovas, MDNPI 1073741369
Title
Owner
Phone
(336) 688-6240

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

1240 N Thornton Ave
Dalton, GA 30720-3605

Mailing address

1240 N Thornton Ave
Dalton, GA 30720-3605
Phone (706) 229-9313

Other names 1

  • Nova Star Medical Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240320002180 GA Part B Supplier - Clinic/Group Practice 0840637393 Receives reassigned benefits from 3 practitioners
Practice locations: Dalton, GA

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
11D2303671Nova Star Medical Clinic1240 N Thornton Avenue, Dalton, GA 30720Certificate of waiverApr 29, 2028

National Provider Directory

National Provider Directory

Locations

1240 N Thornton Ave
Dalton, GA 30720
Phone (706) 229-9313

Practitioners & affiliated clinicians

Practitioners 5

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": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1285401901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 N THORNTON AVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203605",
            "telephone_number": "706-229-9313",
            "fax_number": "706-229-9388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 N THORNTON AVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203605",
            "telephone_number": "706-229-9313",
            "fax_number": "706-229-9388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "VEGA-CASASNOVAS",
        "authorized_official_first_name": "RAMSES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-688-6240",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nova Star Medical Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Nova Star Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.