Active NPI
It'S a Draw
- Clinical Medical Laboratory
- Snellville, GA
National Provider Identifier
1114698040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- IT'S A DRAW
- Practice address
- 1970 Main St E Ste B3
Snellville, GA 30078-6463 - Phone
- (470) 467-4680
- NPI assigned
- Sep 21, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sharonda Forte, NURSE PRACTITIONER
- Title
- Ceo
- Phone
- (270) 987-1338
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary | ||
| Primary Care Nurse Practitioner | 363LP2300X |
Addresses
Primary practice location
1970 Main St E Ste B3
Snellville, GA 30078-6463
Mailing address
1970 Main St E Ste B3
Snellville, GA 30078-6463
Phone (470) 467-4680
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003246533A | Medicaid | GA | |
| 11D2235621 | Other | GA | MOBILE LAB |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.itsadraw.net |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220324000331 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8921496704 | Practice locations: Snellville, GA |
National Provider Directory
National Provider DirectoryLocations
2274 Salem Rd SE
Ste 106411
Conyers, GA 30013
Phone (470) 467-4680
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Atlanta, GA
- NPI 1811134133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632182400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1645747200000",
"number": "1114698040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1970 MAIN ST E STE B3",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300786463",
"telephone_number": "470-467-4680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1970 MAIN ST E STE B3",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300786463",
"telephone_number": "470-467-4680"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IT'S A DRAW",
"organizational_subpart": "NO",
"enumeration_date": "2021-09-21",
"last_updated": "2022-02-25",
"certification_date": "2022-02-25",
"status": "A",
"authorized_official_last_name": "FORTE",
"authorized_official_first_name": "SHARONDA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "270-987-1338",
"authorized_official_credential": "NURSE PRACTITIONER"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
},
{
"code": "363LP2300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Primary Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003246533A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOBILE LAB",
"identifier": "11D2235621",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.itsadraw.net",
"affiliation": "N",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "www.itsadraw.net",
"address_1": "2274 Salem Rd SE Ste 106-411",
"city": "Conyers",
"state": "GA",
"country_code": "US",
"postal_code": "300132097",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Snellville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; 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.