Epiphany Center Rome, Inc

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

10109M Issued in GA

Legal business name

EPIPHANY CENTER ROME, INC

Practice address

308 Glen Milner Blvd
Suite 16
Rome, GA 30161-3268

Phone

(706) 234-4900

Fax

(706) 234-9945

NPI assigned

May 26, 2011

Organization subpart

No

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

Authorized official

Name

Tika S Lewis

Title

Owner

Phone

(770) 500-5062

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1386937159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 GLEN MILNER BLVD",
            "address_2": "SUITE 16",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613268",
            "telephone_number": "706-234-4900",
            "fax_number": "706-234-9945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 GLEN MILNER BLVD",
            "address_2": "SUITE 16",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613268",
            "telephone_number": "706-234-4900",
            "fax_number": "706-234-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY CENTER ROME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "TIKA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-500-5062"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "GA",
            "license": "10109M",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; 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.