NPIMap

Organization Active NPI

Piedmont Professional Services, LLC

  • Nephrology Physician
  • Stockbridge, GA
National Provider Identifier
1104088905
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PIEDMONT PROFESSIONAL SERVICES, LLC
Practice address
1855 Hudson Bridge Rd
Stockbridge, GA 30281-5000
Phone
(770) 801-2500
Fax
(770) 803-2121
NPI assigned
Jul 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Authorized official

Name
Mrs. Christy Aquino
Title
Director of Provider Enrollment
Phone
(470) 271-3427

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X GA
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X GA Primary

Addresses

Primary practice location

1855 Hudson Bridge Rd
Stockbridge, GA 30281-5000

Mailing address

PO Box 102038
Atlanta, GA 30368-2038

Practitioners 582

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

View all 582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081014000187 GA Part B Supplier - Clinic/Group Practice 8921176231 Receives reassigned benefits from 546 practitioners
Practice locations: Lithonia, GA; Loganville, GA; Marietta, GA; McDonough, GA; Newnan, GA; Peachtree City, GA; Powder Springs, GA; Roswell, GA…
O20240213001704 SC Part B Supplier - Clinic/Group Practice 8921176231 Receives reassigned benefits from 35 practitioners
Practice locations: Aiken, SC; North Augusta, SC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1762 Mars Hill Rd NW
Acworth, GA 30101
Phone (678) 732-1506

595 Piedmont Ave NE
Ste 100
Atlanta, GA 30308
Phone (404) 347-9997

1800 Howell Mill Rd NW
Ste 650
Atlanta, GA 30318
Phone (404) 300-3494

3800 Camp Creek Pkwy SW
Atlanta, GA 30331
Phone (470) 217-4393

2855 Old Highway 5
Ste 103
Blue Ridge, GA 30513
Phone (706) 632-2066

2154 Johnson Ferry Rd NE
Brookhaven, GA 30319
Phone (678) 732-1509

1495 Hickory Flat Hwy
Ste 140
Canton, GA 30115

120 Marietta Hwy
Canton, GA 30114
Phone (678) 732-1510

3970 Dep Bill Cantrell Memorial Rd
Ste 203
Cumming, GA 30040
Phone (770) 887-5159

461 Sandy Creek Rd
Ste 3102
Fayetteville, GA 30214

2978 Miller Rd
Lithonia, GA 30038

7530 Roswell Rd
Ste 1
Sandy Springs, GA 30350

7539 Roswell Rd
Sandy Springs, GA 30350
Phone (678) 443-9300

1900 Hudson Bridge Rd
Stockbridge, GA 30281
Phone (770) 506-9818

5320 Memorial Dr
Stone Mountain, GA 30083
Phone (404) 508-6499

325 Georgia Ave
Ste 100
North Augusta, SC 29841
Phone (803) 202-3351

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1104088905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102038",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 HUDSON BRIDGE RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815000",
            "telephone_number": "770-801-2500",
            "fax_number": "770-803-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "AQUINO",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "470-271-3427",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.