NPIMap

Organization Active NPI

Pure Healthcare of Georgia LLC

  • Multi-Specialty Clinic/Center
  • Atlanta, GA
National Provider Identifier
1063184422
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PURE HEALTHCARE OF GEORGIA LLC
Practice address
2340 Perimeter Park Dr Ste 100
Atlanta, GA 30341-1318
Phone
(855) 550-3358
Fax
(801) 327-0211
NPI assigned
Oct 4, 2021
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Joshua Tandy
Title
Director
Phone
(801) 590-9267

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X NU
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2340 Perimeter Park Dr Ste 100
Atlanta, GA 30341-1318

Mailing address

4179 S Riverboat Rd Ste 220
Taylorsville, UT 84123-2986
Phone (855) 550-3358

Other practice location 1

598 Nancy St NW Ste 100
Marietta, GA 30060-1375
Phone (770) 742-6333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220404001298 GA Part B Supplier - Clinic/Group Practice 4385030170 Receives reassigned benefits from 4 practitioners
Practice locations: Atlanta, GA; Marietta, GA

National Provider Directory

National Provider Directory

Locations

598 Nancy St NW
Ste 100
Marietta, GA 30060
Phone (770) 742-6333

Practitioners & affiliated clinicians

Practitioners 7

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": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1063184422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4179 S RIVERBOAT RD STE 220",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841232986",
            "telephone_number": "855-550-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 PERIMETER PARK DR STE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411318",
            "telephone_number": "855-550-3358",
            "fax_number": "801-327-0211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "598 Nancy St NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300601375",
            "country_code": "US",
            "telephone_number": "770-742-6333",
            "fax_number": "801-327-0211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PURE HEALTHCARE OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "TANDY",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "801-590-9267"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.