Epitome Primary Care

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EPITOME PRIMARY CARE

Practice address

631 Campbell Hill St NW Ste 200
Marietta, GA 30060-1390

Phone

(770) 727-6124

NPI assigned

Sep 24, 2024

Organization subpart

No

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

Authorized official

Name

Kenette St-Gourdin, MDNPI 1619506557

Title

Owner

Phone

(912) 695-6080

Specialties & licenses 1

Addresses

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

Practitioners 2

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

• Kenette St-Gourdin, MD

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1619506557
  Medicare reassignment Care Compare group NPD Authorized official
• Windsor Pamphile, MD

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1700048188
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1727136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1023835782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 CAMPBELL HILL ST NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601390",
            "telephone_number": "770-727-6124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 CAMPBELL HILL ST NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601390",
            "telephone_number": "770-727-6124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPITOME PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-24",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "ST-GOURDIN",
        "authorized_official_first_name": "KENETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-695-6080",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold Owen Enoch, DMD
• Brittany Enoghayin
• Ralph Enriquez, RBT
• Entirety Healthcare LLC
• Epiphany Health Studio, Inc.
• Catherine Jean Eppley, LMSW
• Diana Eraydin
• Betty Joyce Erb, MD
• Sarah Erdman, LPC
• Eric Jacobs DMD LLC

• Internal Medicine Physician in Marietta, GA
• Providers in Marietta, 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 Dec 4, 2024; 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.