NPIMap

Organization Active NPI

Clinica Union

  • Family Medicine Physician
  • Roswell, GA
National Provider Identifier
1053787358
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLINICA UNION
Practice address
861 Holcomb Bridge Rd
Ste 200
Roswell, GA 30076-1900
Phone
(770) 992-4455
NPI assigned
Aug 20, 2015
Last updated
Aug 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Mario Rivera, M.DNPI 1831504828
Title
Ceo
Phone
(404) 321-4692

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

861 Holcomb Bridge Rd
Ste 200
Roswell, GA 30076-1900

Mailing address

3369 Buford Hwy NE
Suite 810
Brookhaven, GA 30329-3722
Phone (404) 321-4692

National Provider Directory

National Provider Directory
Tax ID family
Clinica Union Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

861 Holcomb Bridge Rd
Ste 200
Roswell, GA 30076
Phone (770) 910-9276

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1053787358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3369 BUFORD HWY NE",
            "address_2": "SUITE 810",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303293722",
            "telephone_number": "404-321-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 HOLCOMB BRIDGE RD",
            "address_2": "STE 200",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761900",
            "telephone_number": "770-992-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA UNION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-321-4692",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; 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.