Organization Active NPI

CPN Network LLC

  • Family Medicine Physician
  • Powder Springs, GA
National Provider Identifier
1114727765
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CPN NETWORK LLC
Practice address
3380 Florence Rd Ste 200
Powder Springs, GA 30127-3806
Phone
(909) 720-4018
NPI assigned
Mar 13, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Sam Awan
Title
Office Manager
Phone
(909) 720-4018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3380 Florence Rd Ste 200
Powder Springs, GA 30127-3806

Mailing address

3380 Florence Rd Ste 200
Powder Springs, GA 30127-3806
Phone (909) 720-4018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, WI, NY, TX, CA, AL, NC, ND, GA9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20250409001978 IN Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: West Lafayette, IN
O20250411000034 WI Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Milwaukee, WI
O20250411001519 NY Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Tarrytown, NY
O20250414001284 TX Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Austin, TX
O20250416003554 CA Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Riverside, CA
O20250417002230 AL Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Birmingham, AL
O20250424000328 NC Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: Raleigh, NC
O20250514000998 ND Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 1 practitioner
Practice locations: West Fargo, ND
O20250611000164 GA Part B Supplier - Clinic/Group Practice 1052835246 Receives reassigned benefits from 2 practitioners
Practice locations: Powder Springs, GA

National Provider Directory

National Provider Directory

Locations

505 20th St N
Ste 1220
Birmingham, AL 35203
Phone (205) 641-4979

3380 Florence Rd
Ste 200
Powder Springs, GA 30127

5900 Balcones Dr
#8320
Austin, TX 78731

Practitioners 5

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": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1114727765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 FLORENCE RD STE 200",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301273806",
            "telephone_number": "909-720-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 FLORENCE RD STE 200",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301273806",
            "telephone_number": "909-720-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPN NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "AWAN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-720-4018"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Powder Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.