Emir Primary Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

RN143268 Issued in GA

Legal business name

EMIR PRIMARY CARE

Practice address

4930 Governors Dr Ste 409
Forest Park, GA 30297-6101

Phone

(404) 366-3647

Fax

(404) 366-3648

NPI assigned

Jun 17, 2011

Last updated

Jun 17, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles Jenkins III, NPNPI 1841516630

Title

Nurse Practitioner

Phone

(404) 366-3647

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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.

• Charles Jenkins III, APRN

  • Family Nurse Practitioner
  • Forest Park, GA
  • NPI 1841516630
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308268800000",
    "number": "1134414105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 GOVERNORS DR STE 409",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976101",
            "telephone_number": "404-366-3647",
            "fax_number": "404-366-3648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 GOVERNORS DR STE 409",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976101",
            "telephone_number": "404-366-3647",
            "fax_number": "404-366-3648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMIR PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-17",
        "last_updated": "2011-06-17",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "404-366-3647",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "RN143268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Dockery, PHARMD
• Alexander Nicholas Doman, M.D.
• Ducere Investment Group, Inc (Elite Home Care Services)
• Dyvonne LLC
• Salma Elmubarak Elkhabier, MD
• Romina Esmkhani
• Ethical Medical Logistics, LLC
• Angela Evans, DO
• Fahimot Oyinlola Faduyile, M.D.
• Family Pain Management LLC

• Primary Care Clinic/Center in Forest Park, GA
• Providers in Forest Park, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; 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.