Organization Active NPI

Health One Medical Group LLC

  • Internal Medicine Physician
  • Johns Creek, GA
National Provider Identifier
1114355260
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
39141 Issued in GA
Legal business name
HEALTH ONE MEDICAL GROUP LLC
Practice address
10710 Medlock Bridge Rd
Suite 150
Johns Creek, GA 30097-1827
Phone
(770) 497-4188
Fax
(770) 497-4189
NPI assigned
Oct 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

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

Authorized official

Name
Christopher C Kang, MDNPI 1447226808
Title
Owner
Phone
(770) 497-4188

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 39141 GA Primary

Addresses

Primary practice location

10710 Medlock Bridge Rd
Suite 150
Johns Creek, GA 30097-1827

Mailing address

10710 Medlock Bridge Rd
Suite 150
Johns Creek, GA 30097-1827
Phone (770) 497-4188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131209001791 GA Part B Supplier - Clinic/Group Practice 6103053673 Receives reassigned benefits from 3 practitioners
Practice locations: Johns Creek, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2071921Health One Medical Group10710 Medlock Bridge Road, Suite 200, Johns Creek, GA 30097Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory

Locations

10710 Medlock Bridge Rd
Ste 150
Johns Creek, GA 30097
Phone (770) 497-4188

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1114355260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10710 MEDLOCK BRIDGE RD",
            "address_2": "SUITE 150",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971827",
            "telephone_number": "770-497-4188",
            "fax_number": "770-497-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 MEDLOCK BRIDGE RD",
            "address_2": "SUITE 150",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971827",
            "telephone_number": "770-497-4188",
            "fax_number": "770-497-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH ONE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-497-4188",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "39141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.