Coosa Procedure Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

057288 Issued in GA

Legal business name

COOSA PROCEDURE CENTER LLC

Practice address

18 Riverbend Dr SW Ste 120
Rome, GA 30161-6019

Phone

(706) 378-1202

Fax

(706) 378-1204

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Dawnetta Janene Holladay, M.D.

Title

Ceo

Phone

(706) 549-8114

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 11C0001244

Legal name

COOSA PROCEDURE CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 7, 2004

Last certification

Jul 28, 2016

Ownership / control type

Proprietary

Facility address

18 Riverbend Drive, Suite 120
Rome, GA 30161

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515369600000",
    "number": "1821183237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80883",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306080883",
            "telephone_number": "706-549-8114",
            "fax_number": "706-549-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 RIVERBEND DR SW STE 120",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616019",
            "telephone_number": "706-378-1202",
            "fax_number": "706-378-1204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 Riverbend Pkwy",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "30161",
            "country_code": "US",
            "telephone_number": "706-549-8114",
            "fax_number": "706-549-0151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COOSA PROCEDURE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2018-01-08",
        "status": "A",
        "authorized_official_last_name": "HOLLADAY",
        "authorized_official_first_name": "DAWNETTA",
        "authorized_official_middle_name": "JANENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-549-8114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "057288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196957398A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vickie Cooper, RN
• Coosa Eye Clinic, Inc
• Coosa Medical Group
• Coosa Neurology PC
• Coosa Neurosurgery PC
• Coosa Valley Chiropractic, LLC
• Coosa Valley Regional Services
• Coosa Valley Wellness, LLC
• Rose Cope, PTA
• Deanna Barge Cordle, NP-C

• Ambulatory Surgical Clinic/Center in Rome, GA
• Providers in Rome, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.