Active NPI
James T Havens, OD
- Optometrist
- Milledgeville, GA
National Provider Identifier
1417019720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT001328
- Practice address
- 1841 N Columbia St
Milledgeville, GA 31061-2382 - Phone
- (478) 452-3593
- Fax
- (478) 453-0016
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT001328 | GA | Primary |
Addresses
Primary practice location
1841 N Columbia St
Milledgeville, GA 31061-2382
Mailing address
1841 N Columbia St
Milledgeville, GA 31061-2382
Phone (478) 452-3593
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41292 | Other | GA | AVESIS |
| 00624247A | Medicaid | GA | |
| 100922 | Other | GA | AVESIS M'CAID |
| 44334 | Other | GA | SPECTERA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1328 | GA | MD | Addiction (Substance Use Disorder) Counselor |
| OPT001328 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wolf Creek ENT LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Milledgeville, GA
- NPI 1700091980
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417019720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1841 N COLUMBIA ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310612382",
"telephone_number": "478-452-3593",
"fax_number": "478-453-0016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1841 N COLUMBIA ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310612382",
"telephone_number": "478-452-3593",
"fax_number": "478-453-0016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVENS",
"first_name": "JAMES",
"middle_name": "T",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT001328",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS",
"identifier": "41292",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00624247A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS M'CAID",
"identifier": "100922",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "44334",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.