NPIMap

Organization Active NPI

DJTR Holdings Inc

Doing business as crossroads family pharmacy

  • Community/Retail Pharmacy
  • Menlo, GA
National Provider Identifier
1932450293
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009872 Issued in GA
Legal business name
DJTR HOLDINGS INC
Doing business as
crossroads family pharmacy
Practice address
7838 Highway 48
Menlo, GA 30731-6337
Phone
(706) 862-2064
Fax
(706) 862-2477
NPI assigned
Sep 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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

Authorized official

Name
Beverly Ann Moody
Title
Accounting Manager
Phone
(229) 435-4571

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE009872 GA Primary

Addresses

Primary practice location

7838 Highway 48
Menlo, GA 30731-6337

Mailing address

PO Box 72148
Albany, GA 31708-2148
Phone (229) 435-4571

Other identifiers 3

IdentifierTypeStateIssuer
2137023OtherPK
003128088AMedicaidGA
143107MedicaidAL

Other names 1

  • crossroads family pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160510000311 GA Part B Supplier - Mass Immunization (Roster Biller Only) 5496044794 Practice locations: Menlo, GA
O20230810002675 GA Part B Supplier - Mass Immunization (Roster Biller Only) 3375972797 Practice locations: Menlo, 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
DJTR Holdings Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1932450293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72148",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317082148",
            "telephone_number": "229-435-4571",
            "fax_number": "229-435-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7838 HIGHWAY 48",
            "city": "MENLO",
            "state": "GA",
            "postal_code": "307316337",
            "telephone_number": "706-862-2064",
            "fax_number": "706-862-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DJTR HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-27",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "229-435-4571"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137023",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003128088A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143107",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "crossroads family pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "crossroads family pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menlo, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; 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.