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HEART OF GEORGIA PRIMARY CARE LLC NPI 1780244301


NPI Information

NPI: 1780244301
Provider Name: HEART OF GEORGIA PRIMARY CARE, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2251022

Address:
911 PLAZA AVE STE C
EASTMAN, GA
ZIP 31023
Phone: (478) 374-5774
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HEART OF GEORGIA PRIMARY CARE, LLC is a family nurse practitioner in Eastman, GA. HEART OF GEORGIA PRIMARY CARE, LLC NPI is 1780244301. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

911 PLAZA AVE STE C
EASTMAN, GA
ZIP 31023-786
Phone: (478) 374-5774

The provider's authorized official is Amy H Cravey .
The authorized official title is Owner and has the following contact phone number (478) 374-5774.

The CLIA number assigned to this NPI record is 11D2251022 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/17/2019 and was last updated on 2/23/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineNo
2363LF0000XNurse PractitionerFamilyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1296546508FMEDICAIDGEORGIA
2CS2005900319OTHERGEORGIACARESOURCE PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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