NPIMap

Organization Active NPI

Segen Medical Group, P.C.

  • Internal Medicine Physician
  • Austell, GA
National Provider Identifier
1013096882
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
45801 Issued in GA
Legal business name
SEGEN MEDICAL GROUP, P.C.
Practice address
3950 Austell Rd
Austell, GA 30106-1121
Phone
(770) 939-3301
Fax
(770) 939-3331
NPI assigned
Nov 3, 2006
Last updated
Jul 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
Dr. Yacob Ghebremeskel, M.D.NPI 1780765776
Title
Owner
Phone
(770) 939-3301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 45801 GA Primary

Addresses

Primary practice location

3950 Austell Rd
Austell, GA 30106-1121

Mailing address

PO Box 671077
Marietta, GA 30066-0135
Phone (770) 939-3301

National Provider Directory

National Provider Directory

Locations

3605 Sandy Plains Rd
Ste 240283
Marietta, GA 30066

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1013096882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 671077",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300660135",
            "telephone_number": "770-939-3301",
            "fax_number": "770-939-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-939-3301",
            "fax_number": "770-939-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEGEN MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "GHEBREMESKEL",
        "authorized_official_first_name": "YACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-939-3301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "45801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.