NPIMap

Organization Active NPI

Premise Health of Georgia Medical, P.C.

  • Multi-Specialty Clinic/Center
  • Marietta, GA
National Provider Identifier
1013790989
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF GEORGIA MEDICAL, P.C.
Practice address
86 South Cobb Drive Mail Drop 0454
Marietta, GA 30063-0001
Phone
(770) 494-4131
Fax
(770) 494-7490
NPI assigned
Aug 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Will Wright
Title
Legal Counsel
Phone
(615) 577-5893

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

86 South Cobb Drive Mail Drop 0454
Marietta, GA 30063-0001

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • The Wellness Center Operated by Premise Health Marietta North Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Georgia Medical PC50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Locations

86 S Cobb Dr SE
#454
Marietta, GA 30063
Phone (770) 494-4131

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1013790989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 SOUTH COBB DRIVE MAIL DROP 0454",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300630001",
            "telephone_number": "770-494-4131",
            "fax_number": "770-494-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF GEORGIA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "WILL",
        "authorized_official_title_or_position": "LEGAL COUNSEL",
        "authorized_official_telephone_number": "615-577-5893"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wellness Center Operated by Premise Health Marietta North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.