NPIMap

Organization Active NPI

Georgia CVS Pharmacy LLC

  • Pharmacy
  • Macon, GA
National Provider Identifier
1992808752
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
007801 Issued in GA
Legal business name
GEORGIA CVS PHARMACY LLC
Practice address
3012 Hartley Bridge Rd
Macon, GA 31216-5728
Phone
(478) 785-8464
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

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

Authorized official

Name
Susan Colbert
Title
Director, Payer Relations
Phone
(401) 765-1500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 007801 GA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

3012 Hartley Bridge Rd
Macon, GA 31216-5728

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 2

IdentifierTypeStateIssuer
1140780OtherOTHER ID NUMBER-COMMERCIAL NUMBER
P00814032OtherMEDICARE RR

Other names 1

  • CVS PHARMACY 04255 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100209000543 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8123161429 This NPI is an additional NPI on the enrollment
O20110517000364 GA DME Supplier - Pharmacy 8123161429 Practice locations: Macon, GA

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
11D2282798Georgia CVS Pharmacy, LLC Dba CVS/Pharmacy #042553012 Hartley Bridge Road, Macon, GA 31216Certificate of waiverMay 24, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Georgia CVS Pharmacy, L.L.C.3012 Hartley Bridge Rd, Macon, GA 31216-5728(478) 785-1962 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Does not accept assignmentParticipating since Dec 24, 2024

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 06861290 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1992808752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "PO BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 HARTLEY BRIDGE RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312165728",
            "telephone_number": "478-785-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "007801",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1140780",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00814032",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY 04255",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.