NPIMap

Organization Active NPI

Georgia Volunteer Health Care Program

  • Clinic/Center
  • Douglasville, GA
National Provider Identifier
1710437579
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
RN128145 Issued in GA
Legal business name
GEORGIA VOLUNTEER HEALTH CARE PROGRAM
Practice address
6744 Brookfield Way
Douglasville, GA 30134-1461
Phone
(770) 837-5656
NPI assigned
Oct 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Ms. Princess B. Clark, FNP
Title
FNP
Phone
(770) 837-5656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X RN128145 GA Primary

Addresses

Primary practice location

6744 Brookfield Way
Douglasville, GA 30134-1461

Mailing address

6744 Brookfield Way
Douglasville, GA 30134-1461

National Provider Directory

National Provider Directory
Tax ID family
Donahue Furniture18 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1710437579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6744 BROOKFIELD WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6744 BROOKFIELD WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341461",
            "telephone_number": "770-837-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA VOLUNTEER HEALTH CARE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PRINCESS",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "770-837-5656",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "RN128145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.