Clara M Picayo MD Professional Corporation

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

058381 Issued in GA

Legal business name

CLARA M PICAYO MD PROFESSIONAL CORPORATION

Practice address

5570 Bells Ferry Rd
Acworth, GA 30102-2526

Phone

(770) 926-2757

Fax

(770) 926-2758

NPI assigned

Dec 19, 2007

Organization subpart

No

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

Authorized official

Name

Clara M Picayo, MD

Title

Physician / President

Phone

(770) 926-2757

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1104000660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5570 BELLS FERRY RD",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301022526",
            "telephone_number": "770-926-2757",
            "fax_number": "770-926-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5570 BELLS FERRY RD",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301022526",
            "telephone_number": "770-926-2757",
            "fax_number": "770-926-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARA M PICAYO MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "PICAYO",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN / PRESIDENT",
        "authorized_official_telephone_number": "770-926-2757",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "058381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "608406833B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01149193",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katsiaryna Chuprasava, M.D.
• Citadel-Ig
• Civicore LLC
• Clara M Picayo M D P a
• Clara M Picayo MD PC
• Olivia Clark
• Stacy L Cline, FNP-C
• Clinica Santa Maria 2, LLC
• Clinica Santa Maria LLC
• CLJ Healthcare, LLC

• All providers in Acworth, GA
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.