Phoenix Medical Group of Ga LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

053123 Issued in GA

Legal business name

PHOENIX MEDICAL GROUP OF GA LLC

Practice address

917 Jonesboro Road
McDonough, GA 30253-6031

Phone

(678) 814-4901

Fax

(678) 814-4908

NPI assigned

May 13, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Carrie Madej, D.O.

Title

President

Phone

(678) 814-4901

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1013209733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 740209",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303704029",
            "telephone_number": "678-814-4901",
            "fax_number": "678-814-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 JONESBORO ROAD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536031",
            "telephone_number": "678-814-4901",
            "fax_number": "678-814-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MEDICAL GROUP OF GA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "MADEJ",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-814-4901",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "053123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in McDonough, GA
• Providers in McDonough, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.