NPIMap

Organization Active NPI

Southern Health Corp of Ellijay

  • Rural Health Clinic/Center
  • Ellijay, GA
National Provider Identifier
1407062862
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHERN HEALTH CORP OF ELLIJAY
Practice address
822 Industrial Blvd
Ellijay, GA 30540-3804
Phone
(706) 635-5177
NPI assigned
May 15, 2007
Organization subpart
Yes
Parent organization
SOUTHERN HEALTH CORP OF ELLIJAYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Authorized official

Name
Debra Ann Self
Title
Chief Financial Officer
Phone
(706) 276-4741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

822 Industrial Blvd
Ellijay, GA 30540-3804

Mailing address

PO Box 1019
Ellijay, GA 30540-0013
Phone (706) 635-5177

Other names 1

  • Apple Medical Center Doing business as

National Provider Directory

National Provider Directory
Part of
Southern Heatlh Corp DB

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1407062862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1019",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400013",
            "telephone_number": "706-635-5177",
            "fax_number": "706-635-5183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 INDUSTRIAL BLVD",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305403804",
            "telephone_number": "706-635-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "enumeration_date": "2007-05-15",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "706-276-4741"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apple Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.