NPIMap

Organization Active NPI

Evernorth Direct Health LLC

  • Clinic/Center
  • Chatsworth, GA
National Provider Identifier
1871298117
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EVERNORTH DIRECT HEALTH LLC
Practice address
1149 Duvall Rd
Chatsworth, GA 30705-3202
Phone
(706) 422-6104
Fax
(706) 422-8309
NPI assigned
Apr 4, 2023
Last updated
Apr 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERNORTH DIRECT HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Deborah Sue Coolidge
Title
Financial Analysis Senior Manager
Phone
(623) 277-1170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

1149 Duvall Rd
Chatsworth, GA 30705-3202

Mailing address

8888 E Raintree Dr
Scottsdale, AZ 85260-3951

Other names 1

  • Mohawk HLC Miles DVD Family Practice Other name

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Direct Health LLC102 organizations share this tax ID, including this one
Part of
Evernorth Direct Health LLC

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

1149 Duvall Rd
Chatsworth, GA 30705
Phone (706) 422-6104

NPI Registry JSON

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1871298117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8888 E RAINTREE DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 DUVALL RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307053202",
            "telephone_number": "706-422-6104",
            "fax_number": "706-422-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERNORTH DIRECT HEALTH LLC",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "COOLIDGE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "FINANCIAL ANALYSIS SENIOR MANAGER",
        "authorized_official_telephone_number": "623-277-1170"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohawk HLC Miles DVD Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chatsworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.