NPIMap

Organization Active NPI

Floyd County Health Department

Doing business as NW GA Specialty Clinic

  • State or Local Public Health Clinic/Center
  • Rome, GA
National Provider Identifier
1851432173
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
License
025271 Issued in GA
Legal business name
FLOYD COUNTY HEALTH DEPARTMENT
Doing business as
NW GA Specialty Clinic
Practice address
16 East 12TH Street
Suite 202
Rome, GA 30161-4720
Phone
(706) 295-6701
Fax
(706) 295-6697
NPI assigned
Feb 9, 2007
Last updated
Mar 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

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

Authorized official

Name
Dr. Christopher Wade Sellers, M.D.NPI 1427195759
Title
Medical Director
Phone
(706) 295-6704

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X 025271 GA Primary

Addresses

Primary practice location

16 East 12TH Street
Suite 202
Rome, GA 30161-4720

Mailing address

16 East 12TH Street
Suite 202
Rome, GA 30161-4720
Phone (706) 295-6701

Other identifiers 2

IdentifierTypeStateIssuer
000505733DMedicaidGA
000428205DMedicaidGA

Other names 1

  • NW GA Specialty Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001224 GA Part B Supplier - Clinic/Group Practice 6709872245 Receives reassigned benefits from 4 practitioners
Practice locations: Rome, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Floyd County Board of Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

16 E 12th St SW
Ste 202
Rome, GA 30161
Phone (706) 295-6071

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1851432173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 EAST 12TH STREET",
            "address_2": "SUITE 202",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301614720",
            "telephone_number": "706-295-6701",
            "fax_number": "706-295-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 EAST 12TH STREET",
            "address_2": "SUITE 202",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301614720",
            "telephone_number": "706-295-6701",
            "fax_number": "706-295-6697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLOYD COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "706-295-6704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "GA",
            "license": "025271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000505733D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000428205D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW GA Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; 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.