NPIMap

Organization Active NPI

Preston Family Medicine Inc

Doing business as Preston Family Medicine

  • Rural Health Clinic/Center
  • Preston, GA
National Provider Identifier
1053802553
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRESTON FAMILY MEDICINE INC
Doing business as
Preston Family Medicine
Practice address
6381 Hamilton St
Preston, GA 31824-4029
Phone
(229) 828-2118
NPI assigned
May 21, 2018
Last updated
May 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Terry N BryantNPI 1013288505
Title
Owner
Phone
(229) 828-2118

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

6381 Hamilton St
Preston, GA 31824-4029

Mailing address

6381 Hamilton St
Preston, GA 31824-4029
Phone (229) 828-2273

Other names 1

  • PRESTON FAMILY MEDICINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181119002573 GA Part B Supplier - Clinic/Group Practice 8820342355 Receives reassigned benefits from 4 practitioners
Practice locations: Preston, GA
O20190531002088 GA Part A Provider - Rural Health Clinic 8820342355 Receives reassigned benefits from 1 practitioner
Practice locations: Preston, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053802553. Details of each certification follow.

Rural health clinic certification: CCN 118914

Legal name
PRESTON FAMILY MEDICINE INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 11, 2019
Last certification
Mar 10, 2026
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Apr 3, 2018 in GA
Enrollment address
6381 Hamilton St
Preston, GA 31824-4029

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2155051Preston Family Medicine, Inc6381 Hamilton Street, Preston, GA 31824Certificate of waiverSep 23, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23051/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terry N. Bryant Individual 5% Or Greater Direct Ownership InterestCeo Feb 1, 2019 100%
W-2 Managing EmployeeCeo Feb 19, 2019

Practitioners & affiliated clinicians

Practitioners 5

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": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1053802553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6381 HAMILTON ST",
            "city": "PRESTON",
            "state": "GA",
            "postal_code": "318244029",
            "telephone_number": "229-828-2273",
            "fax_number": "229-828-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6381 HAMILTON ST",
            "city": "PRESTON",
            "state": "GA",
            "postal_code": "318244029",
            "telephone_number": "229-828-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON FAMILY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-828-2118"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESTON FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Preston, GA

Sources for this page

Verify at the official NPI Registry.