NPIMap

Organization Active NPI

Synergy Medical Centers, LLC.

  • Specialist
  • Acworth, GA
National Provider Identifier
1093767923
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
018938 Issued in GA
Legal business name
SYNERGY MEDICAL CENTERS, LLC.
Practice address
3889 Cobb Pkwy NW
Acworth, GA 30101-4084
Phone
(770) 975-1299
Fax
(770) 975-1361
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Authorized official

Name
Dr. Vincent BuboloNPI 1518919026
Title
Owner
Phone
(770) 975-1299

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 018938 GA Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X PT006876 GA
Durable Medical Equipment & Medical Supplies 332B00000X 5860470001 GA

Addresses

Primary practice location

3889 Cobb Pkwy NW
Acworth, GA 30101-4084

Mailing address

3889 Cobb Pkwy NW
Acworth, GA 30101-4084
Phone (770) 975-1299

Other identifiers 2

IdentifierTypeStateIssuer
5860470001OtherGACIGNA GOVERNMENT SERVICES
DC7392OtherGARAILROAD PTAN

National Provider Directory

National Provider Directory

Locations

3889 Cobb Pkwy NW
Acworth, GA 30101
Phone (770) 975-1299

3195 Acworth Due West Rd NW
Ste B
Kennesaw, GA 30152
Phone (770) 975-1299

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1093767923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3889 COBB PKWY NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014084",
            "telephone_number": "770-975-1299",
            "fax_number": "770-975-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3889 COBB PKWY NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014084",
            "telephone_number": "770-975-1299",
            "fax_number": "770-975-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY MEDICAL CENTERS, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "BUBOLO",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-975-1299",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "018938",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "PT006876",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "5860470001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOVERNMENT SERVICES",
            "identifier": "5860470001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "DC7392",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; 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.