Organization Active NPI

Northwest Georgia Medical Group, LLC

  • Internal Medicine Physician
  • Calhoun, GA
National Provider Identifier
1285734061
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTHWEST GEORGIA MEDICAL GROUP, LLC
Practice address
400 Timms Rd NE
Calhoun, GA 30701-7016
Phone
(706) 625-0022
Fax
(706) 625-3988
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Authorized official

Name
Neil Gavel
Title
Administrator
Phone
(706) 625-0525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

400 Timms Rd NE
Calhoun, GA 30701-7016

Mailing address

400 Timms Rd NE
Calhoun, GA 30701-7016
Phone (706) 625-0022

Other identifiers 1

IdentifierTypeStateIssuer
260696827AMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1285734061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 TIMMS RD NE",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307017016",
            "telephone_number": "706-625-0022",
            "fax_number": "706-625-4563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 TIMMS RD NE",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307017016",
            "telephone_number": "706-625-0022",
            "fax_number": "706-625-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST GEORGIA MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "GAVEL",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-625-0525"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260696827A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calhoun, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.