Active NPI
Georgia CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy #04719
- Pharmacy
- Watkinsville, GA
National Provider Identifier
1356444103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 006992
- Legal business name
- GEORGIA CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy #04719
- Practice address
- 2080 Hog Mountain Rd
Watkinsville, GA 30677-1953 - Phone
- (706) 769-8031
- NPI assigned
- Sep 7, 2006
- Last updated
- Jan 31, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 006992 | GA | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2080 Hog Mountain Rd
Watkinsville, GA 30677-1953
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS PHARMACY #04719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000543 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8123161429 | This NPI is an additional NPI on the enrollment |
| O20100930031993 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Watkinsville, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2281659 | Georgia CVS Pharmacy, LLC | Certificate of waiver | May 9, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Georgia CVS Pharmacy, L.L.C. | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- CVS Pharmacy 06861
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
2080 Hog Mountain Rd
Watkinsville, GA 30677
Phone (706) 769-8030
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Pharmacist
- Watkinsville, GA
- NPI 1619571940
-
- Pharmacist
- Watkinsville, GA
- NPI 1699581488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1612051200000",
"number": "1356444103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 HOG MOUNTAIN RD",
"city": "WATKINSVILLE",
"state": "GA",
"postal_code": "306771953",
"telephone_number": "706-769-8031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGIA CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2021-01-31",
"certification_date": "2021-01-28",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "GA",
"license": "006992",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #04719",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS PHARMACY #04719",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Watkinsville, GA
- Callie C Gaskins
- Lindsay Gates, RBT
- Amy Gayer, RBT
- Katrina M Geier, NP
- Georgia Center for Aesthetic Plastic Surgery LLC
- Georgia Kidney Consultants, LLC
- Georgia Medical Transportation, Iinc.
- Georgia Ophthalmologists LLC
- Georgia Skin Cancer & Aestheitic Dermatology, LLC
- Georgia Skin Cancer Surgery Center, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2021; 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.