Ellijay Urgent Care & Family Practice LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ELLIJAY URGENT CARE & FAMILY PRACTICE LLC

Doing business as

Ellijay Urgent Care & Family Practice

Practice address

97 Hefner St Ste 202
East Ellijay, GA 30540-8268

Phone

(706) 635-5177

Fax

(706) 635-2274

NPI assigned

Jun 22, 2016

Last updated

Oct 1, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ellijay Urgent Care Family Practice., D.O.

Title

Owner

Phone

(706) 635-5177

Specialties & licenses 2

Addresses

Other names 1

• ELLIJAY URGENT CARE & FAMILY PRACTICE Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700237633. Details of each certification follow.

• CCN 118913 Rural health clinic · Active · Details

Rural health clinic certification: CCN 118913

Legal name

ELLIJAY URGENT CARE & FAMILY PRACTICE, LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 29, 2018

Last certification

Feb 10, 2026

Ownership / control type

1A

Organization structure

LLCProprietary

Incorporated

Jun 16, 2016 in GA

Enrollment address

97 Hefner St
Ste 202
East Ellijay, GA 30540-8268

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Thomas A Nguyen, DO

  • Family Medicine Physician
  • East Ellijay, GA
  • NPI 1669495669

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 2

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.

• Thomas A Nguyen, DO

  • Family Medicine Physician
  • East Ellijay, GA
  • NPI 1669495669
  Medicare reassignment Care Compare group NPD
• Tan D. Nguyen, RPA

  • Physician Assistant
  • East Ellijay, GA
  • NPI 1407140098
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1700237633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 HEFNER ST STE 202",
            "city": "EAST ELLIJAY",
            "state": "GA",
            "postal_code": "305408268",
            "telephone_number": "706-635-2273",
            "fax_number": "706-635-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 HEFNER ST STE 202",
            "city": "EAST ELLIJAY",
            "state": "GA",
            "postal_code": "305408268",
            "telephone_number": "706-635-5177",
            "fax_number": "706-635-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIJAY URGENT CARE & FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "PRACTICE.",
        "authorized_official_first_name": "ELLIJAY URGENT CARE",
        "authorized_official_middle_name": "FAMILY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-635-5177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "062579",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELLIJAY URGENT CARE & FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cardiovascular Imaging of North Georgia LLC
• John Walsh Davis, D.C.
• Paul Edward Deshane, PTA
• Digestive Healthcare of Ga, P.C. (Digestive Healthcare of GA Ellijay)
• Jan Wood Dowda, RPH
• Islam G Eltarawy, MD
• Envision a Chiropractic Healing, LLC
• Linda Diane Everett, M.S., CCC-SLP
• Family Life Chiropractic Center, LLC
• Fannin Regional Hospital Inc (Tri County Diagnostic Center)

• Rural Health Clinic/Center in East Ellijay, GA
• Providers in East Ellijay, GA by specialty
• Rural Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.