NPIMap

Organization Active NPI

The Family Health Centers of Georgia, Inc

  • Federally Qualified Health Center (FQHC)
  • Marietta, GA
National Provider Identifier
1285727396
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE FAMILY HEALTH CENTERS OF GEORGIA, INC
Practice address
805 Campbell Hill St NW
Marietta, GA 30060-1144
Phone
(770) 919-0025
Fax
(678) 569-0228
NPI assigned
Oct 2, 2006
Organization subpart
Yes
Parent organization
THE FAMILY HEALTH CENTERS OF GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Dr. Michael W Brooks, MDNPI 1174513089
Title
Ceo
Phone
(404) 752-1400

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
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

805 Campbell Hill St NW
Marietta, GA 30060-1144

Mailing address

805 Campbell Hill St NW
Marietta, GA 30060-1144
Phone (770) 919-0025

Other identifiers 1

IdentifierTypeStateIssuer
000437478JMedicaidGA

Other names 1

  • The Family Health Center @ Cobb Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040413000807 GA Part B Supplier - Clinic/Group Practice 2062406903 Receives reassigned benefits from 38 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rome, GA; Morrow, GA; Atlanta, GA; Marietta, GA; Douglasville, GA
O20110317000226 GA Part A Provider - Federally Qualified Health Center (FQHC) 2062406903 Practice locations: Marietta, GA

Federally qualified health center certification: CCN 111939

Legal name
THE FAMILY HEALTH CENTERS OF GEORGIA, INC
Doing business as
THE FAMILY HEALTH CENTER @ COBB
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 22, 2011
Last certification
Mar 22, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 1992 in GA
Enrollment address
805 Campbell Hill Street
Marietta, GA 30060-1761

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
West End Medical Centers the Family Health Center Bolton Village14 organizations share this tax ID, including this one
Part of
West End Medical Centers the Family Health Center Bolton Village

Other organizations with this tax ID 13

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

View all 13

Locations

8277 Connally Dr
Douglasville, GA 30134

805 Campbell Hill St NW
Marietta, GA 30060
Phone (770) 919-0025

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Stephanie Smith Individual Corporate OfficerBoard Member Jan 1, 2024
Michael W Brooks Individual 5% Or Greater Indirect Ownership InterestPresident & Chief Executive Officer Aug 1, 2010
W-2 Managing Employee Jun 1, 2009
Tracy E Dillon Individual Corporate OfficerBoard Member Jan 1, 2024
Jan J Williams Individual Corporate OfficerBoard Member Jan 1, 2024
Uwonda Carter Individual Corporate OfficerBoard Member Jan 1, 2024
Matthew Worthy Individual Corporate OfficerBoard Member Jan 1, 2024
Sanquinetta Maria Dover Individual Corporate OfficerBoard Member Jan 1, 2024
Rita Gibson Individual Corporate OfficerBoard Member Jan 1, 2024
Donna Lynne Hubbard Individual Corporate OfficerBoard Member Jan 1, 2024
Lamont Pierre McIntosh Individual Corporate OfficerBoard Member Jan 1, 2024
Janice S Andrews Individual Corporate OfficerBoard Member Jan 1, 2024
Michael Taylor Individual Corporate OfficerBoard Member Jan 1, 2024
Reginald Mebane Individual Corporate OfficerBoard Member Jan 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1285727396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CAMPBELL HILL ST NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601144",
            "telephone_number": "770-919-0025",
            "fax_number": "678-388-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 CAMPBELL HILL ST NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601144",
            "telephone_number": "770-919-0025",
            "fax_number": "678-569-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FAMILY HEALTH CENTERS OF GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE FAMILY HEALTH CENTERS OF GEORGIA, INC",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-752-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000437478J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Family Health Center @ Cobb",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Family Health Center @ Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.