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MED-SOUTH PRIMARY CARE NPI 1245413715


NPI Information

NPI: 1245413715
Provider Name: MED-SOUTH PRIMARY CARE

Former Legal Business Name: MED-SOUTH PRIMARY CARE

Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 11D2052600

Address:
1240 EAGLES LANDING PARKWAY
SUITE 100
STOCKBRIDGE, GA
ZIP 30281
Phone: (770) 506-0100
Get Directions

MED-SOUTH PRIMARY CARE is an internal medicine in Stockbridge, GA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. MED-SOUTH PRIMARY CARE NPI is 1245413715. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Med-south Primary Care.

The provider's business location address is:

1240 EAGLES LANDING PARKWAY
SUITE 100
STOCKBRIDGE, GA
ZIP 30281
Phone: (770) 506-0100
Fax: (770) 507-2597

The provider's authorized official is Kelly Marie Padgett .
The authorized official title is Insurance Coordinator and has the following contact phone number (770) 506-0100.

The CLIA number assigned to this NPI record is 11D2052600 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/7/2007 and was last updated on 12/14/2015.


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
1207R00000XInternal Medicine047830GEORGIAYes

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
1H53729MEDICARE UPINGEORGIA
211BDVGJMEDICARE PINGEORGIA
300932357AMEDICAIDGEORGIA

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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