NPIMap

Organization Active NPI

TMC Haralson Family Healthcare Center

Doing business as Primary Care of Bremen

  • Rural Health Clinic/Center
  • Bremen, GA
National Provider Identifier
1992710610
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TMC HARALSON FAMILY HEALTHCARE CENTER
Doing business as
Primary Care of Bremen
Practice address
204 Allen Memorial Dr
Suite 201
Bremen, GA 30110-2047
Phone
(770) 537-6500
Fax
(770) 824-2600
NPI assigned
Jul 30, 2006
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Clint Hoffman
Title
Sr VP Operations
Phone
(770) 838-8845

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

204 Allen Memorial Dr
Suite 201
Bremen, GA 30110-2047

Mailing address

100 Greenway Blvd FL 2
Carrollton, GA 30117-4338
Phone (770) 838-8787

Other identifiers 3

IdentifierTypeStateIssuer
300033792AMedicaidGA
DG2920OtherGAMEDICARE ID
367607289AOtherGACLINIC RENDERING

Other names 1

  • Primary Care of Bremen Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030404000017 GA Part A Provider - Rural Health Clinic 8729997846 Practice locations: Bremen, GA
O20040429000440 GA Part B Supplier - Clinic/Group Practice 8729997846 Receives reassigned benefits from 13 practitioners
Practice locations: Bremen, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992710610. Details of each certification follow.

Rural health clinic certification: CCN 118505

Legal name
TMC HARALSON FAMILY HEALTHCARE CENTER
Doing business as
PRIMARY CARE OF BREMEN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 8, 2003
Last certification
Feb 17, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 8, 1998 in GA
Enrollment address
204 Allen Memorial Dr
Ste 201
Bremen, GA 30110-2062
Related CCNs
111320

Facilities connected through Provider of Services related, parent or unit certification numbers.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0256127Haralson Family Healthcare Center204 Allen Memorial Drive, Suite 201, Bremen, GA 30110Certificate of waiverMar 20, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

204 Allen Memorial Dr
Ste 201
Bremen, GA 30110
Phone (770) 537-6500

25 W Lyon St
Tallapoosa, GA 30176
Phone (770) 812-2800

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
TMC/Higgins General Hospital Organization, Bremen, GA 5% Or Greater Direct Ownership Interest Feb 1, 2003
Susan Fox Individual Corporate OfficerVP of Operations Mar 7, 2012
W-2 Managing EmployeeVP of Operations Mar 7, 2012
Jillian Ragsdale Individual Corporate DirectorVP of Finance Feb 12, 2010

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1992710610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GREENWAY BLVD FL 2",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174338",
            "telephone_number": "770-838-8787",
            "fax_number": "770-812-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 ALLEN MEMORIAL DR",
            "address_2": "SUITE 201",
            "city": "BREMEN",
            "state": "GA",
            "postal_code": "301102047",
            "telephone_number": "770-537-6500",
            "fax_number": "770-824-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMC HARALSON FAMILY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "SR VP OPERATIONS",
        "authorized_official_telephone_number": "770-838-8845"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300033792A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "DG2920",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC RENDERING",
            "identifier": "367607289A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care of Bremen",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primary Care of Bremen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bremen, GA

Sources for this page

Verify at the official NPI Registry.