NPIMap

Organization Active NPI

Northeast Georgia Diagnostic Associates and Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gainesville, GA
National Provider Identifier
1144719311
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
NORTHEAST GEORGIA DIAGNOSTIC ASSOCIATES AND CLINIC, LLC
Practice address
1240 Jesse Jewell Pkwy SE Ste 500
Gainesville, GA 30501-3861
Phone
(855) 709-4535
NPI assigned
May 3, 2018
Last updated
Sep 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Authorized official

Name
Amy E Fouts
Title
Chief Compliance Officer
Phone
(404) 851-6968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1240 Jesse Jewell Pkwy SE Ste 500
Gainesville, GA 30501-3861

Mailing address

1100 Johnson Fy Rd NE Ste 780
Atlanta, GA 30342-1743

Other practice location 1

1255 Friendship Rd Ste 230
Braselton, GA 30517-5620
Phone (470) 228-7700

Other practice location 2

1485 Jesse Jewell Pkwy NE Ste 330
Gainesville, GA 30501-3896
Phone (470) 228-7700

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181114000949 GA Part B Supplier - Clinic/Group Practice 1951655737 Receives reassigned benefits from 87 practitioners
Practice locations: Snellville, GA; Macon, GA; Lawrenceville, GA; Canton, GA; Gainesville, GA; Duluth, GA; Demorest, GA; Cumming, GA…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2163211Northeast Georgia Diagnostic Associates1255 Friendship Road, Suite 230, Braselton, GA 30517AccreditationJul 30, 2027
11D2169857Northeast Georgia Associates and Clinic1485 Jesse Jewell Parkway, SE, Suite 330, Gainesville, GA 30501AccreditationMar 6, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1255 Friendship Rd
Ste 100
Braselton, GA 30517
Phone (470) 228-7900

1255 Friendship Rd
Ste 220
Braselton, GA 30517

1270 Friendship Rd
Ste 130
Braselton, GA 30517

2800 Buford Dr
Ste 200
Buford, GA 30519
Phone (678) 344-3744

1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501

1276 Jesse Jewell Pkwy SE
Ste A
Gainesville, GA 30501
Phone (470) 228-7900

1276 Jesse Jewell Pkwy SE
Ste C
Gainesville, GA 30501
Phone (678) 450-3625

500 Medical Center Blvd
Ste 160
Lawrenceville, GA 30046
Phone (770) 979-0367

Practitioners & affiliated clinicians

Practitioners 88

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 88

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1144719311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 JOHNSON FY RD NE STE 780",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 JESSE JEWELL PKWY SE STE 500",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013861",
            "telephone_number": "855-709-4535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1255 Friendship Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175620",
            "country_code": "US",
            "telephone_number": "470-228-7700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1485 Jesse Jewell Pkwy NE Ste 330",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013896",
            "country_code": "US",
            "telephone_number": "470-228-7700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA DIAGNOSTIC ASSOCIATES AND CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-03",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "FOUTS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "404-851-6968"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct",
            "address_2": "Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.