Organization Active NPI

Enterprise Family Healthcare

  • Primary Care Clinic/Center
  • Macon, GA
National Provider Identifier
1760668586
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
040767 Issued in GA
Legal business name
ENTERPRISE FAMILY HEALTHCARE
Practice address
2192 Ingleside Ave
Macon, GA 31204-2030
Phone
(478) 745-9880
Fax
(478) 745-8611
NPI assigned
Jan 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Ms. Dana M Harrelson
Title
Office Manager
Phone
(478) 745-9559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 040767 GA Primary

Addresses

Primary practice location

2192 Ingleside Ave
Macon, GA 31204-2030

Mailing address

2192 Ingleside Ave
Macon, GA 31204-2030
Phone (478) 745-9880

Other identifiers 1

IdentifierTypeStateIssuer
GRP4689OtherGAMEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1760668586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2192 INGLESIDE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042030",
            "telephone_number": "478-745-9880",
            "fax_number": "478-745-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2192 INGLESIDE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042030",
            "telephone_number": "478-745-9880",
            "fax_number": "478-745-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTERPRISE FAMILY HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "HARRELSON",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "478-745-9559",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "040767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP4689",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.