NPIMap

Organization Active NPI

Egleston Affiliated Services

  • Urgent Care Clinic/Center
  • Austell, GA
National Provider Identifier
1750455952
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
044-079 Issued in GA
Legal business name
EGLESTON AFFILIATED SERVICES
Practice address
2041 Mesa Valley Way
Suite 185
Austell, GA 30106
Phone
(404) 785-8900
NPI assigned
Nov 20, 2006
Last updated
Apr 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Authorized official

Name
Louetta Cody
Title
Manager, Provider Enrollment
Phone
(404) 785-7876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 044-079 GA Primary

Addresses

Primary practice location

2041 Mesa Valley Way
Suite 185
Austell, GA 30106

Mailing address

1584 Tullie Cir NE
Atlanta, GA 30329-2311
Phone (404) 785-7928

Other names 1

  • Children's Healthcare of Atlanta at West Cobb Other name

National Provider Directory

National Provider Directory
Tax ID family
Children's Healthcare of Atlanta at Mount Zion7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1750455952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1584 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292311",
            "telephone_number": "404-785-7928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 MESA VALLEY WAY",
            "address_2": "SUITE 185",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "30106",
            "telephone_number": "404-785-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGLESTON AFFILIATED SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "CODY",
        "authorized_official_first_name": "LOUETTA",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "404-785-7876"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "GA",
            "license": "044-079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Healthcare of Atlanta at West Cobb",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Children's Healthcare of Atlanta at West Cobb",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; 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.