Express Clinic, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EXPRESS CLINIC, LLC

Practice address

3350 Steve Reynolds Blvd
Ste 408
Duluth, GA 30096

Phone

(678) 783-4449

NPI assigned

Mar 24, 2022

Organization subpart

No

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

Authorized official

Name

Solomon Matovu

Title

Ceo

Phone

(678) 783-4927

Specialties & licenses 1

Addresses

Other names 1

• EXPRESS CLINIC Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Judith Namakula, N.P-C

  • Family Nurse Practitioner
  • Duluth, GA
  • NPI 1932467768
  Medicare reassignment NPD

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1023768090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3628 SATELLITE BLVD UNIT 958236",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300950489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 STEVE REYNOLDS BLVD",
            "address_2": "STE 408",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "678-783-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2023-08-23",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "MATOVU",
        "authorized_official_first_name": "SOLOMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-783-4927"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXPRESS CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "EXPRESS CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Experience a Home LLC
• Express Pharmacy Inc (Express Pharmacy)
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• Eye Site of Duluth, Inc
• Eye1St Vision & Laser, LLC (Eye1st Vision)
• Tina Betty Ezeolisah, DNP, PMHNP-BC

• General Practice Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.