Champion Fit Wellness

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

CHAMPION FIT WELLNESS

Practice address

3617 Salem Rd
Covington, GA 30016-4552

Phone

(678) 212-0496

Fax

(678) 212-0219

NPI assigned

Jan 30, 2008

Last updated

Jan 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Caroline Porter Dotson, LCSW

Title

Program Coordinator

Phone

(713) 467-7600

Specialties & licenses 1

Addresses

Other names 1

• Champion Fit Wellness, LLC Other name

Locations

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1851578074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10661 HADDINGTON DR",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770433287",
            "telephone_number": "713-467-7600",
            "fax_number": "713-467-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 SALEM RD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164552",
            "telephone_number": "678-212-0496",
            "fax_number": "678-212-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION FIT WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "DOTSON",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_middle_name": "PORTER",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "713-467-7600",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champion Fit Wellness, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Michael P Cecil, M.D.
• Shakquanda Lakisha Cepeda
• Sheila Yvette Channel
• Nirmala Sowbhagya Chelliah, M.D.
• Michael Cheng, M.D.
• George Jules Chevalier IV
• Raynecia Chisolm, RN

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Covington, GA
• Providers in Covington, GA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Georgia

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