Active NPI
Enterprise Family Healthcare
- Primary Care Clinic/Center
- Macon, GA
National Provider Identifier
1760668586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 040767
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRP4689 | Other | GA | MEDICARE GROUP NUMBER |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Macon, GA
- NPI 1215911102
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.