NPIMap

Organization Active NPI

C-Worth Family Walk-in Clinic

  • Family Nurse Practitioner
  • Chatsworth, GA
National Provider Identifier
1982945135
Registry record updated Mar 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN115578 Issued in GA
Legal business name
C-WORTH FAMILY WALK-IN CLINIC
Practice address
2976 Highway 76
Ste B
Chatsworth, GA 30705-6981
Phone
(706) 517-0656
Fax
(706) 517-0651
NPI assigned
Mar 13, 2013
Last updated
Mar 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2013

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

Authorized official

Name
Mr. Kelly Ray Elliott, FNP-BCNPI 1497798532
Title
President
Phone
(706) 517-0656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X RN115578 GA Primary

Addresses

Primary practice location

2976 Highway 76
Ste B
Chatsworth, GA 30705-6981

Mailing address

2976 Highway 76
Ste B
Chatsworth, GA 30705-6981
Phone (706) 517-0656

National Provider Directory

National Provider Directory
Tax ID family
C-Worth Family Walk-in Clinic4 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.

Locations

2976 Highway 76
Ste B
Chatsworth, GA 30705
Phone (706) 517-0656

Practitioners & affiliated clinicians

Practitioners 2

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": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363132800000",
    "number": "1982945135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 HIGHWAY 76",
            "address_2": "STE B",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307056981",
            "telephone_number": "706-517-0656",
            "fax_number": "706-517-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 HIGHWAY 76",
            "address_2": "STE B",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307056981",
            "telephone_number": "706-517-0656",
            "fax_number": "706-517-0651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C-WORTH FAMILY WALK-IN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-13",
        "last_updated": "2013-03-13",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-517-0656",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN115578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 13, 2013; 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.