NPIMap

Organization Active NPI

Caritas Medical Center Fayetteville LLC

  • Nephrology Physician
  • Stockbridge, GA
National Provider Identifier
1801572003
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
CARITAS MEDICAL CENTER FAYETTEVILLE LLC
Practice address
105 N Park TRL Ste 300
Stockbridge, GA 30281-7432
Phone
(678) 284-0800
Fax
(678) 284-9299
NPI assigned
Jun 23, 2023
Organization subpart
Yes
Parent organization
CARITAS MEDICAL CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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

Authorized official

Name
Mrs. Veraline Ovadje
Title
Office Manager
Phone
(678) 284-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

105 N Park TRL Ste 300
Stockbridge, GA 30281-7432

Mailing address

105 N Park TRL Ste 300
Stockbridge, GA 30281-7432
Phone (678) 284-0800

Other names 1

  • CARITAS MEDICAL CENTER LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231023000566 GA Part B Supplier - Clinic/Group Practice 4082060447 Receives reassigned benefits from 1 practitioner
Practice locations: Fayetteville, GA

National Provider Directory

National Provider Directory
Part of
Caritas Medical Center

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.

Practitioners & affiliated clinicians

Practitioners 9

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": "1687478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1801572003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N PARK TRL STE 300",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817432",
            "telephone_number": "678-284-0800",
            "fax_number": "678-284-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N PARK TRL STE 300",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817432",
            "telephone_number": "678-284-0800",
            "fax_number": "678-284-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARITAS MEDICAL CENTER FAYETTEVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARITAS MEDICAL CENTER LLC",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "OVADJE",
        "authorized_official_first_name": "VERALINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-284-0800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARITAS MEDICAL CENTER LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.