Organization Active NPI

Joint Health and Wellness of Georgia LLC

  • Internal Medicine Physician
  • Griffin, GA
National Provider Identifier
1619631355
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JOINT HEALTH AND WELLNESS OF GEORGIA LLC
Practice address
230 W College St Ste C
Griffin, GA 30224-4249
Phone
(678) 871-3735
NPI assigned
Oct 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Mr. Derek Shahn Hall
Title
Managing Member
Phone
(404) 734-8139

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

230 W College St Ste C
Griffin, GA 30224-4249

Mailing address

230 W College St Ste C
Griffin, GA 30224-4249
Phone (678) 871-3735

Other practice location 1

718 S 8th St Ste B
Griffin, GA 30224-4827
Phone (404) 734-8139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220119003034 GA Part B Supplier - Clinic/Group Practice 1850783002 Receives reassigned benefits from 1 practitioner
Practice locations: Griffin, GA

National Provider Directory

National Provider Directory

Locations

718 S 8th St
#B
Griffin, GA 30224
Phone (770) 228-1711

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1619631355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 W COLLEGE ST STE C",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244249",
            "telephone_number": "678-871-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 W COLLEGE ST STE C",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244249",
            "telephone_number": "678-871-3735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "718 S 8th St Ste B",
            "address_purpose": "LOCATION",
            "city": "Griffin",
            "state": "GA",
            "postal_code": "302244827",
            "country_code": "US",
            "telephone_number": "404-734-8139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JOINT HEALTH AND WELLNESS OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-28",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SHAHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "404-734-8139",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Griffin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.