Tracie Chislom

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Practice address

1002 W Solomon St
Griffin, GA 30223-2632

Phone

(678) 557-2613

NPI assigned

Mar 8, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KJ Adult Care ,LLC

  • Adult Day Care Clinic/Center
  • Griffin, GA
  • NPI 1003431438
  NPD Authorized official

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

{
    "created_epoch": "1552003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552003200000",
    "number": "1801354774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 W SOLOMON ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232632",
            "telephone_number": "678-557-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 W SOLOMON ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232632",
            "telephone_number": "678-557-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISLOM",
        "first_name": "TRACIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-08",
        "last_updated": "2019-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candra Janee Cherry
• Richard Douglas Chewning, MD
• Leslie Anita Chiang, DO
• Reba Childers, PT, DPT
• Gloria Chine, NP
• Brittni B. Chitwood, PA-C
• Eun Ji Choi, PHARMD
• Choice Lab, Inc
• Dimpi Chokshi, PHARMD
• Christian Ministries Hospice, Inc

• Adult Day Care Clinic/Center in Griffin, GA
• Providers in Griffin, GA by specialty
• Adult Day Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; 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.