Eagle'S Landing Longevity Center

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

39958 Issued in GA

Legal business name

EAGLE'S LANDING LONGEVITY CENTER

Practice address

1325 Rock Quarry Rd
Suite 200
Stockbridge, GA 30281-5088

Phone

(770) 389-0734

Fax

(770) 389-5364

NPI assigned

Oct 24, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Gayla Deneice Sylvain, M.DNPI 1104925106

Title

Owner

Phone

(770) 389-0734

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 4

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

• Gayla Denise Sylvain, MD

  • Internal Medicine Physician
  • Stockbridge, GA
  • NPI 1104925106
  Medicare reassignment Care Compare group NPD Authorized official
• Noellemarie Barrera, D.O.

  • Internal Medicine Physician
  • Stockbridge, GA
  • NPI 1720224850
  Medicare reassignment Care Compare group NPD
• Angelique Young, ARNP

  • Family Nurse Practitioner
  • Stockbridge, GA
  • NPI 1598160046
  Medicare reassignment NPD
• Gabrielle Valliere-White, FNP-C

  • Family Nurse Practitioner
  • Fayetteville, GA
  • NPI 1720769813

  Internal Medicine

  NPD

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1134524788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 ROCK QUARRY RD",
            "address_2": "SUITE 200",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815088",
            "telephone_number": "770-389-0734",
            "fax_number": "770-389-5364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 ROCK QUARRY RD",
            "address_2": "SUITE 200",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815088",
            "telephone_number": "770-389-0734",
            "fax_number": "770-389-5364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE'S LANDING LONGEVITY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "SYLVAIN",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_middle_name": "DENEICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-389-0734",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "39958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynamic Healthcare
• Dynamic Kids Therapy Services
• E Cares Nursing Staff Services
• E-Z Ride Home Transportation Services LLC
• Eagle Chiropractic Clinic Inc
• Eagle'S Landing OB GYN 2 LLC
• Eagle'S Landing Pharmacy
• Eagle'S Landing Pharmacy
• Eagle'S Wings Healthcare Services, Inc.
• Eagles Landing Diabetes and Endocrinology

• Internal Medicine Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.