NPIMap

Organization Active NPI

Peachtree Cardiovascular Surgeons at Saint Joseph'S LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Atlanta, GA
National Provider Identifier
1093021172
Registry record updated Jul 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
PEACHTREE CARDIOVASCULAR SURGEONS AT SAINT JOSEPH'S LLC
Practice address
5665 Peachtree Dunwoody Rd NE
Suite 200
Atlanta, GA 30342-1764
Phone
(404) 252-6104
Fax
(404) 257-1808
NPI assigned
Aug 26, 2010
Organization subpart
Yes
Parent organization
SAINT JOSEPH MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2011

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

Authorized official

Name
Mrs. Robyn K Freedman
Title
Finance Administrator
Phone
(770) 579-1894

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

5665 Peachtree Dunwoody Rd NE
Suite 200
Atlanta, GA 30342-1764

Mailing address

PO Box 70547
Marietta, GA 30007-0547
Phone (770) 579-1894

Other identifiers 1

IdentifierTypeStateIssuer
003101143AMedicaidGA

National Provider Directory

National Provider Directory
Part of
The Medical Group of Saint Joseph'S LLC

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310428800000",
    "number": "1093021172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70547",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300070547",
            "telephone_number": "770-579-1894",
            "fax_number": "770-579-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421764",
            "telephone_number": "404-252-6104",
            "fax_number": "404-257-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE CARDIOVASCULAR SURGEONS AT SAINT JOSEPH'S LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT JOSEPH MEDICAL GROUP",
        "enumeration_date": "2010-08-26",
        "last_updated": "2011-07-12",
        "status": "A",
        "authorized_official_last_name": "FREEDMAN",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "FINANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-579-1894",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003101143A",
            "state": "GA"
        }
    ],
    "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 Jul 12, 2011; 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.