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HAZLEHURST FAMILY CLINIC LLC
NPI 1578743985
Family Medicine in Douglas, GA

Active since November 14, 2007CLIA 11D1029234 · Waiver
906 BRYAN ST W, DOUGLAS, GA 31533(912) 383-9300(912) 383-9292 Get Directions Write a Review

NPPES record last updated: November 14, 2007. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Hazlehurst Family Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAZLEHURST FAMILY CLINIC LLC (NPI 1578743985) is a healthcare organization registered as a family medicine in Douglas, Georgia and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through March 2, 2027 and lists Umamaheswari Jonnalagadda, Officer, as its authorized official.

NPPES Registry Identity

NPI1578743985
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameHAZLEHURST FAMILY CLINIC LLC
Location Address906 BRYAN ST WDouglas, GA 31533-2330
Mailing Address906 Bryan St WDouglas, GA 31533-2330 · (912) 383-9300 · Fax (912) 383-9292
Phone(912) 383-9300
Fax(912) 383-9292
Organization SubpartNo
Authorized OfficialUmamaheswari JonnalagaddaOfficer · (912) 383-9300
Enumeration DateNovember 14, 2007
✔ NPI 1578743985 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in GA · GA042299
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
906 BRYAN ST W, Douglas, GA 31533
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Other Identifiers 1

Medicare PINGRP6528GA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Hazlehurst Family Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Hazlehurst Family Clinic LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Umamaheswari Jonnalagadda, MD
Family Practice
NPI 1538152855
906 BRYAN ST W
Douglas, GA 31533
(912) 383-9300
✔ PECOS✔ Accepts MedicareSame address
Kelsea Fender, FNP
Nurse Practitioner
NPI 1275207771
906 BRYAN ST W
Douglas, GA 31533
(912) 383-9300
✔ PECOS✔ Accepts MedicareSame address
Leslie Evans, FNP-C
Nurse Practitioner
NPI 1881231538
906 BRYAN ST W
Douglas, GA 31533
(912) 383-9300
✔ PECOS0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D1029234

Hazlehurst Family Clinic LLC · Douglas, GA
Active · expires Mar 2, 2027
CLIA Number11D1029234
Laboratory TypePhysician Office
Certificate Effective DateMarch 3, 2025
Certificate Expiration DateMarch 2, 2027
Laboratory DirectorUmamahesudari Jonnalagadda
Laboratory Phone(912) 383-9300
Laboratory LocationHazlehurst Family Clinic LLC906 West Bryan Street, Douglas, GA 31533
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Hazlehurst Family Clinic LLC's NPI number?

The NPI number for Hazlehurst Family Clinic LLC is 1578743985. It was assigned to this organization in the NPPES registry on November 14, 2007.

Where is Hazlehurst Family Clinic LLC located?

Hazlehurst Family Clinic LLC is located at 906 Bryan St W, Douglas, GA 31533. The listed phone number is (912) 383-9300.

What is Hazlehurst Family Clinic LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Hazlehurst Family Clinic LLC enrolled in Medicare?

Yes. Hazlehurst Family Clinic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Hazlehurst Family Clinic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Hazlehurst Family Clinic LLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Hazlehurst Family Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1029234) is associated with this NPI, valid through March 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Hazlehurst Family Clinic LLC was last updated on November 14, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.