NPIMap

Organization Active NPI

North Georgia Urology Center, PC, Inc

  • Urology Physician
  • Dalton, GA
National Provider Identifier
1861413197
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
050482 Issued in GA
Legal business name
NORTH GEORGIA UROLOGY CENTER, PC, INC
Practice address
1434 Broadrick Drive
North Georgia Urology Center
Dalton, GA 30720
Phone
(706) 278-5961
Fax
(706) 275-0280
NPI assigned
Jul 21, 2006
Last updated
Oct 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Authorized official

Name
Clista Tallent
Title
Practice Manager
Phone
(706) 278-5961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 050482 GA Primary

Addresses

Primary practice location

1434 Broadrick Drive
North Georgia Urology Center
Dalton, GA 30720

Mailing address

1434 Broadrick Drive
Dalton, GA 30720-3009
Phone (706) 278-5961

Other identifiers 3

IdentifierTypeStateIssuer
429126502AMedicaidGA
8913681MedicaidGA
00931312AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040706000589 GA Part B Supplier - Clinic/Group Practice 1951388180 Receives reassigned benefits from 9 practitioners
Practice locations: Dalton, GA
O20101004000422 GA DME Supplier - Physician - Urology 1951388180 Practice locations: Dalton, GA

National Provider Directory

National Provider Directory

Locations

1434 Broadrick Dr
Dalton, GA 30720
Phone (706) 278-5961

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGHABD

Practitioners & affiliated clinicians

Practitioners 9

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": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1861413197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 BROADRICK DRIVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203009",
            "telephone_number": "706-278-5961",
            "fax_number": "706-275-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1434 BROADRICK DRIVE",
            "address_2": "NORTH GEORGIA UROLOGY CENTER",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-278-5961",
            "fax_number": "706-275-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH GEORGIA UROLOGY CENTER, PC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "TALLENT",
        "authorized_official_first_name": "CLISTA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "706-278-5961"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "050482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429126502A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8913681",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00931312A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.