NPIMap

Organization Active NPI

Southeastern Rheumatology Alliance

  • Rheumatology Physician
  • Gainesville, GA
National Provider Identifier
1114795663
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Practice address
700 S Enota Dr NE
Gainesville, GA 30501-2403
Phone
(770) 531-3711
Fax
(678) 696-8386
NPI assigned
Dec 14, 2023
Last updated
Apr 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Michael Cullen
Title
Practice Administrator
Phone
(770) 531-3711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

700 S Enota Dr NE
Gainesville, GA 30501-2403

Mailing address

700 S Enota Dr NE
Gainesville, GA 30501-2403
Phone (770) 531-3711

Other practice location 1

1715 Resurgence Drive
Suite 201
Watkinsville, GA 30677-7306
Phone (706) 410-9270

Other practice location 2

23 Plantation Park Dr Ste 101
Bluffton, SC 29910-6072
Phone (912) 349-4227

Other practice location 3

980 Johnson Fy Rd NE Ste 220
Atlanta, GA 30342-1623
Phone (404) 255-5956

Other practice location 4

5400 Waters Ave
Savannah, GA 31404-6234
Phone (912) 349-4227

Other practice location 5

1816 Eagle Dr Ste 200-B
Woodstock, GA 30189-8274
Phone (404) 255-5956

Other practice location 6

110 Rushing Ln Ste B
Statesboro, GA 30458-6027
Phone (912) 210-0276

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240411001547 GA Part B Supplier - Clinic/Group Practice 2466891353 Receives reassigned benefits from 25 practitioners
Practice locations: Gainesville, GA; Atlanta, GA; Woodstock, GA; Watkinsville, GA; Savannah, GA; Statesboro, GA
O20240415001911 SC Part B Supplier - Clinic/Group Practice 2466891353 Receives reassigned benefits from 7 practitioners
Practice locations: Bluffton, SC; Charleston, SC

National Provider Directory

National Provider Directory

Locations

1816 Eagle Dr
Ste 200-B
Woodstock, GA 30189
Phone (404) 255-5956

1579 Savannah Hwy
Ste D
Charleston, SC 29407
Phone (678) 262-9923

Ownership & related parties

Subparts reporting this organization as parent 6

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1114795663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S ENOTA DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012403",
            "telephone_number": "770-531-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S ENOTA DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012403",
            "telephone_number": "770-531-3711",
            "fax_number": "678-696-8386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1715 RESURGENCE DRIVE",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777306",
            "country_code": "US",
            "telephone_number": "706-410-9270",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23 Plantation Park Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299106072",
            "country_code": "US",
            "telephone_number": "912-349-4227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "980 Johnson Fy Rd NE Ste 220",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421623",
            "country_code": "US",
            "telephone_number": "404-255-5956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5400 Waters Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314046234",
            "country_code": "US",
            "telephone_number": "912-349-4227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1816 Eagle Dr Ste 200-B",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301898274",
            "country_code": "US",
            "telephone_number": "404-255-5956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 Rushing Ln Ste B",
            "address_purpose": "LOCATION",
            "city": "Statesboro",
            "state": "GA",
            "postal_code": "304586027",
            "country_code": "US",
            "telephone_number": "912-210-0276",
            "fax_number": "912-428-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN RHEUMATOLOGY ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-14",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "CULLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-531-3711"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.