Etowah Emergency Physicians, LLC
Organization Active NPI Emergency Medicine Physician · Cedartown, GA
NPI 1306388343 · NPPES record last updated Feb 19, 2026
Key facts
- NPI
- 1306388343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- ETOWAH EMERGENCY PHYSICIANS, LLC
- Practice address
- 2360 Rockmart Hwy
Cedartown, GA 30125-6029 - Phone
- (770) 748-2500
- NPI assigned
- Nov 8, 2016
- Organization subpart
- No
Authorized official
- Name
- Kim H Larsen
- Title
- Director of Credentialing
- Phone
- (770) 874-5400
Other NPIs on the same Medicare enrollment 1
Practitioners 38
-
Garrett H Barnes, M.D.
-
Timothy Wayne Champion, FNP-CFRN-NRP
-
Kimberly Erin Cook, NP-C
-
Kim Carlos Farmer, FNP
-
Cody Folsom, NP
-
Darrius Guiden, MD
-
William Cory Harrison, NP-C
-
Hannah Bell Helton, FNP
-
Brian A Horton, NP
-
Stanley L Hoy, M.D.
-
Imtiaz Ahmad Khan, M.D.
-
Kristina Maddox, NP
-
George E Malcom Jr., M.D.
-
Phillip Taylor Meadows, FNP-C
-
Lara Millikan Ranic, ACNPC-AG
-
Douglas Lamar Page Jr., NP-C
-
Jennifer Kay Vernon, FNP - C
-
Molly R Vicchrilli, M.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170307000640 | GA | Part B Supplier - Clinic/Group Practice | 1456635697 |
Receives reassigned benefits from 115 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cedartown, GA; Rome, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
2360 Rockmart Hwy
Cedartown, GA 30125-6029
Mailing address
PO Box 21663
Belfast, ME 04915-4113
Phone (770) 874-5400
Other providers in Cedartown, GA
- Amanda B Dworkin
- Karen Ann Eberhart
- Carol P. Edwards
- Gerson Escondo
- Veronica Escutia
- Jennifer Elaine Eubanks
- Pamela Jo Evans
- Mark Joseph Faulkner
- Kimber Fields
- Michael Figueras
All providers in Cedartown, GA · Emergency Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.