Middle Georgia Total Health Center, LLC
Organization Active NPI Chiropractor · Eastman, GA
NPI 1700516366 · NPPES record last updated Jun 22, 2022
Key facts
- NPI
- 1700516366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- MIDDLE GEORGIA TOTAL HEALTH CENTER, LLC
- Practice address
- 285 Plaza Ave
Eastman, GA 31023-6859 - Phone
- (478) 374-6011
- Fax
- (478) 374-7702
- NPI assigned
- Jun 15, 2022
- Organization subpart
- No
Authorized official
- Name
- Dustin Phillip Smith, DC
- Title
- Doctor/Owner
- Phone
- (478) 374-6011
Practitioners 1
-
Dustin Phillip Smith, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220808003032 | GA | Part B Supplier - Clinic/Group Practice | 7517349517 |
Receives reassigned benefits from 1 practitioner Practice locations: Cochran, GA; Eastman, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
285 Plaza Ave
Eastman, GA 31023-6859
Mailing address
285 Plaza Ave
Eastman, GA 31023-6859
Phone (478) 374-6011
Other practice location 1
126 N 2nd St
Cochran, GA 31014-6330
Phone (478) 374-6011
Other providers in Eastman, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.