NPIMap

Organization Active NPI

Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
National Provider Identifier
1013313857
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIVIA MEDICAL GROUP OF GEORGIA LLC
Practice address
101 Yorktown Dr
Fayetteville, GA 30214-1578
Phone
(770) 460-4285
NPI assigned
Nov 5, 2014
Last updated
Mar 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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

Authorized official

Name
Jeannette Wood
Title
VP Revenue Cycle Manager
Phone
(301) 672-2645

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

101 Yorktown Dr
Fayetteville, GA 30214-1578

Mailing address

950 N Glebe Rd Ste 700
Arlington, VA 22203-4173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150325000983 GA Part B Supplier - Clinic/Group Practice 4284951542 Receives reassigned benefits from 828 practitioners
O20190820000359 SC Part B Supplier - Clinic/Group Practice 4284951542 Receives reassigned benefits from 4 practitioners
Practice locations: Hilton Head, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

3400 Old Milton Pkwy
Ste C395
Alpharetta, GA 30005
Phone (678) 384-4911

116 W Church St
Americus, GA 31709
Phone (229) 410-4990

1810 Mulkey Rd
Ste 200
Austell, GA 30106
Phone (678) 402-6970

522 Greenwood St
Barnesville, GA 30204
Phone (770) 872-3663

63 Pleasant Hill Rd
Blairsville, GA 30512
Phone (706) 745-2229

1604 12th St
Columbus, GA 31906
Phone (706) 324-0471

1010 E Freeway Dr SE
Conyers, GA 30094
Phone (770) 922-8222

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

101 Yorktown Dr
Ste 200
Fayetteville, GA 30214
Phone (770) 460-4281

101 Hartford Rd W
Ste 101
Fort Gaines, GA 39851
Phone (229) 210-2100

4343 Shallowford Rd
Ste 410
Marietta, GA 30062
Phone (678) 384-4911

Networks

  • SC HMO

Practitioners & affiliated clinicians

Practitioners 854

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.

View all 854

NPI Registry JSON

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1013313857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 700",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222034173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 YORKTOWN DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141578",
            "telephone_number": "770-460-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "VP REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "301-672-2645"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.