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  7. NPI Record 1396996955

CHATTAHOOCHEE VALLEY FAMILY MEDICINE INC
Complete NPI Record 1396996955
Clinic/Center - Primary Care in Columbus, GA

NPI Status: Active since October 01, 2008

Contact Information

7413 WHITESVILLE RD
SUITE 700
COLUMBUS, GA
ZIP 31904
Phone: (706) 570-5337

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider First Line Business Practice Location Address
  13. Provider Second Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Is Organization Subpart
  31. Authorized Official Name Prefix Text
  32. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1396996955. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1396996955
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Entity Type Code: 2
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Employer Identification Number EIN: UNAVAIL
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Mailing Address: 7413 WHITESVILLE RD
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Second Line Business Mailing Address: SUITE 700
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: COLUMBUS
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: GA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 319043227
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7065705337
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 7413 WHITESVILLE RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 700
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: COLUMBUS
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: GA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 319043227
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7065705337
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/1/2008
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 10/1/2008
The date that a record was last updated or changed.
Authorized Official Last Name: EDWARDS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: TANIA
The first name of the authorized official.
Authorized Official Middle Name: CHRISTINE
The middle name of the authorized official.
Authorized Official Title or Position: PHYSICIAN/PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 7065705337
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QP2300X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 053465
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: GA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: D.O.