Centerwell Senior Primary Care Ga PC
Organization Active NPI Internal Medicine Physician · Atlanta, GA
NPI 1013672815 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1013672815
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE GA PC
- Practice address
- 2056 Donald Lee Hollowell Pkwy NW Ste 1
Atlanta, GA 30318-4764 - Phone
- (470) 890-3910
- Fax
- (877) 445-5270
- NPI assigned
- Nov 5, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE GA PC
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 12
Corporate family (same tax ID) 12
Practitioners 11
-
Michelle Adegbemle, FNP
-
Chena Yvonne Allen, FNP
-
Katina M New, FNP-C
-
Abiola Olutayo Ojewole, M.D.
-
Dmitriy M Pelishev, D.O.
-
Pei-Chun McGregor, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2261240 | Centerwell Senior Primary Care - Grove Park | Certificate of waiver | May 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210901004313 | GA | Part B Supplier - Clinic/Group Practice | 3274939061 |
Receives reassigned benefits from 69 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Atlanta, GA; Woodstock, GA; Suwanee, GA; Stone Mountain, GA; South Fulton, GA; Savannah, GA; Morrow, GA; Marietta, GA… |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care Ga PC
- Part of
- Centerwell Senior Primary Care Ga PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
2056 Donald Lee Hollowell Pkwy NW Ste 1
Atlanta, GA 30318-4764
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000
Other names
- CenterWell Senior Primary Care- Grove Park
Other providers in Atlanta, GA
- Centered on You Counseling and Consulting
- Centers for Disease Control and Prevention, US Public Health Service
- Centers for Orhtopedic Rehabilitation
- Centers for Orthopedic Rehabilitation
- Centerwell Certified Healthcare Corp.
- Centerwell Senior Primary Care Ga PC
- Centerwell Senior Primary Care Ga PC
- Centiva Homecare, Inc.
- Melissa Centofante
- Central Medical Group, Inc.
All providers in Atlanta, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.