NPIMap

Organization Active NPI

Temple Medical LLC

Doing business as TempleMed Health

  • Family Medicine Physician
  • Villa Rica, GA
National Provider Identifier
1740406438
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
RN101917-NP Issued in GA
Legal business name
TEMPLE MEDICAL LLC
Doing business as
TempleMed Health
Practice address
503 Main St
Villa Rica, GA 30180-1931
Phone
(770) 462-1170
Fax
(770) 462-1174
NPI assigned
Apr 18, 2007
Last updated
Aug 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Lori A Hudson
Title
Owner Provider
Phone
(770) 462-1170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RN101917-NP GA Primary

Addresses

Primary practice location

503 Main St
Villa Rica, GA 30180-1931

Mailing address

503 Main St
Villa Rica, GA 30180-1931
Phone (805) 869-3240

Other identifiers 1

IdentifierTypeStateIssuer
000805153CMedicaidGA

Other names 1

  • TempleMed Health Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2186880Temple Med Health503 Main Street, Villa Rica, GA 30180Certificate of waiverJun 22, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1740406438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 MAIN ST",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801931",
            "telephone_number": "805-869-3240",
            "fax_number": "770-462-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 MAIN ST",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801931",
            "telephone_number": "770-462-1170",
            "fax_number": "770-462-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER PROVIDER",
        "authorized_official_telephone_number": "770-462-1170"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "RN101917-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000805153C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TempleMed Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.