Medmark Treatment Centers of Georgia, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

MEDMARK TREATMENT CENTERS OF GEORGIA, INC.

Doing business as

MedMark Treatment Centers Chatsworth

Practice address

1289 Gi Maddox Pkwy
Chatsworth, GA 30705-2069

Phone

(706) 971-3366

Fax

(214) 550-2635

NPI assigned

Apr 27, 2018

Organization subpart

No

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

Authorized official

Name

Bruce Jarvie

Title

VP, Treasurer

Phone

(214) 379-3300

Specialties & licenses 2

Addresses

Other names 1

• MedMark Treatment Centers Chatsworth Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Medmark Treatment Centers of Georgia, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Blairsville, GA
  • NPI 1316186968

  O20200107003450

  Same enrollment

Tax ID family

Medmark Treatment Centers of Georgia Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Medmark Treatment Centers of Georgia, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Blairsville, GA
  • NPI 1316186968
  NPD tax ID
• Medmark Treatment Centers of Georgia, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Columbus, GA
  • NPI 1770913287
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Columbus Addiction Associates, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Columbus, GA
  • NPI 1700244415

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Anthony Witt, MD

  • Family Medicine Physician
  • Beavercreek, OH
  • NPI 1154373199
  NPD (past)

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1477041143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300",
            "fax_number": "214-853-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 GI MADDOX PKWY",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307052069",
            "telephone_number": "706-971-3366",
            "fax_number": "214-550-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDMARK TREATMENT CENTERS OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2025-09-12",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Chatsworth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shairoz Shelina Manji, M.D.
• John Everette McGee, PHARMD
• Dax McKay, MD
• Travis McKie-Voerste, LPC, NCC, ACS
• Mauricio Andres Medina Mieles, MD
• Richard A Mersberger, D.O.
• Jessica Headrick Metcalf, DPT
• Valorie J Mixon, PAC
• Lisa Monath, BS, CADCII
• Lolybeth Yolanda Montero, LMSW

• Substance Use Disorder Rehabilitation Clinic/Center in Chatsworth, GA
• Providers in Chatsworth, GA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; 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.