NPIMap

Organization Active NPI

Charlton Memorial Hospital

Doing business as Family Practice Clinic

  • Rural Health Clinic/Center
  • Folkston, GA
National Provider Identifier
1760548002
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHARLTON MEMORIAL HOSPITAL
Doing business as
Family Practice Clinic
Practice address
2383 Third St
Folkston, GA 31537-8917
Phone
(912) 496-2697
Fax
(912) 496-1139
NPI assigned
Dec 29, 2006
Last updated
Jul 26, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
CHARLTON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

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

Authorized official

Name
Ms. Fatima McCasland
Title
Clinic Director
Phone
(912) 496-2697

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2383 Third St
Folkston, GA 31537-8917

Mailing address

2383 Third St
Folkston, GA 31537-8917
Phone (912) 496-2697

Other identifiers 3

IdentifierTypeStateIssuer
164482236AMedicaidGA
HOSP45OtherGAMEDICARE PART B PTAN
814096430AMedicaidGA

Other names 1

  • Family Practice Clinic Doing business as

National Provider Directory

National Provider Directory
Part of
Charlton Memorial Hospital

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1760548002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2383 THIRD ST",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315378917",
            "telephone_number": "912-496-2697",
            "fax_number": "912-496-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2383 THIRD ST",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315378917",
            "telephone_number": "912-496-2697",
            "fax_number": "912-496-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLTON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLTON MEMORIAL HOSPITAL",
        "enumeration_date": "2006-12-29",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "MCCASLAND",
        "authorized_official_first_name": "FATIMA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "912-496-2697",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164482236A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "HOSP45",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "814096430A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Folkston, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; 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.