NPIMap

Organization Active NPI

Estate Clinics by CMG

  • Internal Medicine Physician
  • Riverdale, GA
National Provider Identifier
1043981517
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ESTATE CLINICS BY CMG
Practice address
107 Upper Riverdale Rd SW
Riverdale, GA 30274-2504
Phone
(770) 997-2160
NPI assigned
Sep 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Kaylene Martin
Title
Practice Manager
Phone
(770) 990-8212

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Multi-Specialty Clinic/Center 261QM1300X
Research Clinic/Center 261QR1100X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

107 Upper Riverdale Rd SW
Riverdale, GA 30274-2504

Mailing address

483 Upper Riverdale Rd SW Ste F
Riverdale, GA 30274-2579
Phone (770) 742-3883

National Provider Directory

National Provider Directory

Locations

11 Upper Riverdale Rd SW
Bldg 33
Riverdale, GA 30274
Phone (770) 997-2160

107 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (229) 333-1000

Practitioners & affiliated clinicians

Practitioners 3

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": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1043981517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 UPPER RIVERDALE RD SW STE F",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742579",
            "telephone_number": "770-742-3883",
            "fax_number": "855-597-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742504",
            "telephone_number": "770-997-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTATE CLINICS BY CMG",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KAYLENE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-990-8212"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.