NPIMap

Organization Active NPI

Coffee County Board of Health

Doing business as Coffee Wellness Center

  • Public Health or Welfare Agency
  • Douglas, GA
National Provider Identifier
1316976699
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
COFFEE COUNTY BOARD OF HEALTH
Doing business as
Coffee Wellness Center
Practice address
1003 Shirley Ave
Douglas, GA 31533-2123
Phone
(912) 389-4586
Fax
(913) 389-4590
NPI assigned
Jun 30, 2006
Last updated
Dec 11, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COFFEE COUNTY BOARD OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Authorized official

Name
Starla Sutton
Title
Pso
Phone
(912) 338-5263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

1003 Shirley Ave
Douglas, GA 31533-2123

Mailing address

1003 Shirley Ave
Douglas, GA 31533-2123
Phone (912) 389-4586

Other names 1

  • Coffee Wellness Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427000232 GA Part B Supplier - Clinic/Group Practice 7416944087 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Douglas, GA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Nicholls Clinic2 organizations share this tax ID, including this one
Part of
Nicholls Clinic

Other organizations with this tax ID 1

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

Locations

1003 Shirley Ave
Douglas, GA 31533
Phone (912) 389-4204

1101 Church St
Waycross, GA 31501
Phone (912) 285-6010

1102 Plant Ave
Waycross, GA 31501
Phone (912) 285-6002

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1316976699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 SHIRLEY AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332123",
            "telephone_number": "912-389-4586",
            "fax_number": "913-389-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 SHIRLEY AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332123",
            "telephone_number": "912-389-4586",
            "fax_number": "913-389-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE COUNTY BOARD OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COFFEE COUNTY BOARD OF HEALTH",
        "enumeration_date": "2006-06-30",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "STARLA",
        "authorized_official_title_or_position": "PSO",
        "authorized_official_telephone_number": "912-338-5263"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coffee Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.