Terry Supanee Chongulia, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

053640 Issued in 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

Last updated

Feb 1, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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, PCGroup PAC ID 6204722697, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Walton Hospital Hospital, Monroe, GA, CCN 110046
• Piedmont Eastside Medical Center Hospital, Snellville, GA, CCN 110192

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Women's Health Associates of Walton, PC

  • Obstetrics & Gynecology Physician
  • Monroe, GA
  • NPI 1053416966
  Medicare reassignment Care Compare group
• Piedmont Walton Hospital Inc

  • General Acute Care Hospital
  • Monroe, GA
  • NPI 1720589328
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastside Medical Center, LLC

  dba Piedmont Eastside Medical Center

  • General Acute Care Hospital
  • Snellville, GA
  • NPI 1467406132
  Care Compare affiliation
• Piedmont Walton Hospital Inc

  • General Acute Care Hospital
  • Monroe, GA
  • NPI 1720589328
  Care Compare affiliation

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1992800742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 HILLSIDE TRCE",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306555880",
            "telephone_number": "770-267-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 GREAT OAKS DR STE A",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306558211",
            "telephone_number": "770-267-8368",
            "fax_number": "770-207-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHONGULIA",
        "first_name": "TERRY",
        "middle_name": "SUPANEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "053640",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "053640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443409802B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "52872342",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Chang, M.D.
• Leyla Tasmaz Chenevey, D.C.
• Rosemary Chickos, D.O.
• Child & Family Therapy Solutions, Inc.
• Children & Adult Therapy Services
• Shannon Christian, MD
• Chronic Disease Management of Georgia, LLC
• Circle of Care, Inc (Comfort Keepers)
• Pamela R. Clack, P.T.
• Thalaline Mayer Clack, PT, DPT

• Obstetrics & Gynecology Physician in Monroe, GA
• Providers in Monroe, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.