NPIMap

Organization Active NPI

Georgia Department of Human Resources

Doing business as Floyd County BOH- Mobile Dental Van

  • State or Local Public Health Clinic/Center
  • Rome, GA
National Provider Identifier
1679614515
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
License
025271 Issued in GA
Legal business name
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Doing business as
Floyd County BOH- Mobile Dental Van
Practice address
1309 Redmond Rd NW
Rome, GA 30165-1307
Phone
(706) 802-5343
Fax
(706) 802-5681
NPI assigned
Feb 12, 2007
Last updated
Jul 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

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

Authorized official

Name
Dr. Christopher Wade Sellers, M.D.NPI 1427195759
Title
Medical Director
Phone
(706) 295-6704

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X 025271 GA Primary

Addresses

Primary practice location

1309 Redmond Rd NW
Rome, GA 30165-1307

Mailing address

1309 Redmond Rd NW
Rome, GA 30165-1307
Phone (706) 802-5343

Other identifiers 10

IdentifierTypeStateIssuer
000926879HMedicaidGA
0009288679BMedicaidGA
000926879MedicaidGA
000926879AMedicaidGA
000926879DMedicaidGA
000926879BMedicaidGA
000926879EMedicaidGA
000926879GMedicaidGA
000926879IMedicaidGA
000926879FMedicaidGA

Other names 1

  • Floyd County BOH- Mobile Dental Van Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Floyd County Board of Health6 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

1309 Redmond Rd NW
Rome, GA 30165
Phone (706) 295-6571

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1679614515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 REDMOND RD NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651307",
            "telephone_number": "706-802-5343",
            "fax_number": "706-802-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 REDMOND RD NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651307",
            "telephone_number": "706-802-5343",
            "fax_number": "706-802-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DEPARTMENT OF HUMAN RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "706-295-6704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "GA",
            "license": "025271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009288679B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879I",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926879F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Floyd County BOH- Mobile Dental Van",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.