NPIMap

Organization Active NPI

Southern Health Corp of Ellijay

Doing business as North Georgia Orthopedic Surgery and Sports Medicine Center

  • General Acute Care Hospital
  • East Ellijay, GA
National Provider Identifier
1619284445
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
053942 Issued in GA
Legal business name
SOUTHERN HEALTH CORP OF ELLIJAY
Doing business as
North Georgia Orthopedic Surgery and Sports Medicine Center
Practice address
772 Maddox Dr
Suite 112
East Ellijay, GA 30540-8194
Phone
(706) 276-4399
Fax
(706) 276-4741
NPI assigned
Aug 31, 2010
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ms. Debra Ann Self
Title
Cfo
Phone
(706) 276-4741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 053942 GA Primary

Addresses

Primary practice location

772 Maddox Dr
Suite 112
East Ellijay, GA 30540-8194

Mailing address

PO Box 1019
Ellijay, GA 30540-0013
Phone (706) 276-4399

Other identifiers 2

IdentifierTypeStateIssuer
1821059510OtherGABRIAN ROWAN'S NPI NUMBER
HOSP34OtherGASOUTHERN HEALTH CORP OF ELLIJAYDBA NORTH GEORGIA MEDICAL CENTER PROVIDER NUMBER

Other names 1

  • North Georgia Orthopedic Surgery and Sports Medicine Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Georgia Medical C6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

772 Maddox Dr
Ste 112
East Ellijay, GA 30540
Phone (706) 276-4399

NPI Registry JSON

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1619284445",
    "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": "706-276-4399",
            "fax_number": "706-276-4741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "772 MADDOX DR",
            "address_2": "SUITE 112",
            "city": "EAST ELLIJAY",
            "state": "GA",
            "postal_code": "305408194",
            "telephone_number": "706-276-4399",
            "fax_number": "706-276-4741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "706-276-4741",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "053942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRIAN ROWAN'S NPI NUMBER",
            "identifier": "1821059510",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH CORP OF ELLIJAYDBA NORTH GEORGIA MEDICAL CENTER PROVIDER NUMBER",
            "identifier": "HOSP34",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Georgia Orthopedic Surgery and Sports Medicine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.