Individual provider Active NPI

Emmanuel Gwibuka

  • Family Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1063248631
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN253946 Issued in GA
Practice address
1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606
Phone
(404) 851-8000
NPI assigned
Sep 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN253946 GA Primary

Addresses

Primary practice location

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606

Mailing address

776 Donington Cir
Lawrenceville, GA 30045-3576
Phone (404) 933-7792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119004846 GA Practitioner - Nurse Practitioner 6305371931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone (770) 844-3200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Cardiovascular Professional Services, LLC CurrentSince Dec 16, 2024 Accepting new patients

Locations

1200 Northside Forsyth Dr
Cumming, GA 30041
Phone (770) 292-4806

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1063248631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "776 DONINGTON CIR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453576",
            "telephone_number": "404-933-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWIBUKA",
        "first_name": "EMMANUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN253946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.