Sexual Assault Center of Northwest Georgia, Inc

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

APC005441 Issued in GA

Legal business name

SEXUAL ASSAULT CENTER OF NORTHWEST GEORGIA, INC

Practice address

414 Shorter Ave NW
Rome, GA 30165-4274

Phone

(706) 292-9024

Fax

(706) 292-0114

NPI assigned

Sep 19, 2016

Organization subpart

No

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

Authorized official

Name

Kim Davis

Title

Executive Director

Phone

70629299024

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1871041848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 SHORTER AVE NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 SHORTER AVE NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654274",
            "telephone_number": "706-292-9024",
            "fax_number": "706-292-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEXUAL ASSAULT CENTER OF NORTHWEST GEORGIA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "70629299024"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "APC005441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23566666",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Sellers, DO
• Ashley Sellers
• Christopher Wade Sellers, M.D., M.P.H.
• Nisitha Sengottuvel, MD, PHD
• Seven Hills Counseling Center
• Mohammadi Shabbir, M.D.
• Harsh Manishbhai Shah, M.B.B.S
• Ahmad Shahrukh, M.D.
• Stuart Paul Shaklee, COTA/L
• Shannon Pharmacy

• Adult Mental Health Clinic/Center in Rome, GA
• Providers in Rome, GA by specialty
• Adult Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.