Terry Supanee Chongulia, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Monroe, GA
NPI 1992800742 · NPPES record last updated Feb 1, 2016
Key facts
- NPI
- 1992800742
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 053640 (GA)
- Practice address
- 513 Great Oaks Dr Ste a
Monroe, GA 30655-8211 - Phone
- (770) 267-8368
- Fax
- (770) 207-0640
- NPI assigned
- Sep 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of Chicago, Pritzker School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Women'S Health Associates of Walton, PC
Practice addresses (Care Compare)
513 Great Oaks Dr
Suite a
Monroe, GA 30655-8232
Phone 7702678368205
Hospital & facility affiliations
- Piedmont Walton Hospital
- Piedmont Eastside Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040227000537 | GA | Practitioner - Obstetrics/Gynecology | 3274429675 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053640 | GA | MD | Legal Medicine |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piedmont Walton Hospital Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Legal Medicine | 173000000X | 053640 | GA | |
| Obstetrics & Gynecology Physician | 207V00000X | 053640 | GA | Yes |
Addresses
Primary practice location
513 Great Oaks Dr Ste a
Monroe, GA 30655-8211
Mailing address
2370 Hillside Trce
Monroe, GA 30655-5880
Phone (770) 267-0085
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 443409802B | Medicaid | GA | |
| 52872342 | Other | GA | BC/BS |
Other providers in Monroe, GA
- Samuel Chang
- Leyla Tasmaz Chenevey
- Rosemary Chickos
- Child & Family Therapy Solutions, Inc.
- Children & Adult Therapy Services
- Shannon Christian
- Chronic Disease Management of Georgia, LLC
- Circle of Care, Inc
- Pamela R. Clack
- Thalaline Mayer Clack
All providers in Monroe, GA · Obstetrics & Gynecology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.