NPIMap

Organization Active NPI

Southern Health Corp of Ellijay

Doing business as Internal Medicine of North Georgia

  • Internal Medicine Physician
  • Ellijay, GA
National Provider Identifier
1790932655
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
010925 Issued in GA
Legal business name
SOUTHERN HEALTH CORP OF ELLIJAY
Doing business as
Internal Medicine of North Georgia
Practice address
190 Hospital Cir
Ellijay, GA 30540-9694
Phone
(706) 698-7400
Fax
(706) 698-7401
NPI assigned
Aug 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Authorized official

Name
Ms. Debbie A Self
Title
Chief Financial Officer
Phone
(706) 276-4741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 010925 GA Primary

Addresses

Primary practice location

190 Hospital Cir
Ellijay, GA 30540-9694

Mailing address

PO Box 1019
Ellijay, GA 30540-0013
Phone (706) 635-5177

Other names 1

  • Internal Medicine of North Georgia Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southern Heatlh Corp DB6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1790932655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1019",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400013",
            "telephone_number": "706-635-5177",
            "fax_number": "706-635-5183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 HOSPITAL CIR",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305409694",
            "telephone_number": "706-698-7400",
            "fax_number": "706-698-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "706-276-4741",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "010925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine of North Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.