NPIMap

Organization Active NPI

Prestige Advanced Healthcare

  • Primary Care Clinic/Center
  • Lagrange, GA
National Provider Identifier
1942736160
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
233631 Issued in GA
Legal business name
PRESTIGE ADVANCED HEALTHCARE
Practice address
102 Main St Ste 204
Lagrange, GA 30240-3225
Phone
(706) 756-5317
Fax
(844) 740-1379
NPI assigned
May 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Authorized official

Name
Cierra Nicole Williams
Title
Nurse Practitioner
Phone
(470) 295-9981

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 233631 GA Primary

Addresses

Primary practice location

102 Main St Ste 204
Lagrange, GA 30240-3225

Mailing address

43 Brisbane CT
Newnan, GA 30263-2370
Phone (470) 295-9981

Other identifiers 1

IdentifierTypeStateIssuer
1730557752OtherGANURSE PRACTITIONER

National Provider Directory

National Provider Directory

Locations

102 Main St
Ste 204
Lagrange, GA 30240
Phone (706) 530-0944

815 3rd Ave
Ste A
West Point, GA 31833
Phone (706) 416-7837

NPI Registry JSON

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

{
    "created_epoch": "1494201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539820800000",
    "number": "1942736160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 BRISBANE CT",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302632370",
            "telephone_number": "470-295-9981",
            "fax_number": "844-740-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MAIN ST STE 204",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302403225",
            "telephone_number": "706-756-5317",
            "fax_number": "844-740-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE ADVANCED HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-08",
        "last_updated": "2018-10-18",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CIERRA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "470-295-9981"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "233631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "1730557752",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; 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.