Id Group of Atlanta

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

049992 Issued in GA

Legal business name

ID GROUP OF ATLANTA

Practice address

735 Piedmont Avenue, NE
Atlanta, GA 30308

Phone

(404) 588-4680

NPI assigned

Dec 16, 2013

Organization subpart

No

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

Authorized official

Name

John P Ouderkirk, MD

Title

Member

Phone

(404) 588-4680

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387152000000",
    "number": "1063833267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 PIEDMONT AVENUE, NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30308",
            "telephone_number": "404-588-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 PIEDMONT AVENUE, NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30308",
            "telephone_number": "404-588-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID GROUP OF ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-16",
        "last_updated": "2013-12-16",
        "status": "A",
        "authorized_official_last_name": "OUDERKIRK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "404-588-4680",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "GA",
            "license": "049992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000926318A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Atlanta, GA by specialty
• Non-Pharmacy Dispensing Site in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; 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.