NPIMap

Individual provider Active NPI

Michael Wayne Brooks, M.D.

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1174513089
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
029420 Issued in GA
Practice address
868 York Ave SW
Atlanta, GA 30310-2750
Phone
(404) 752-1400
Fax
(404) 758-0740
NPI assigned
Oct 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical & Laboratory Immunology (Allergy & Immunology) Physician 207KI0005X 029420 GA
Internal Medicine Physician 207R00000X 029420 GA Primary

Addresses

Primary practice location

868 York Ave SW
Atlanta, GA 30310-2750

Mailing address

868 York Ave SW
Atlanta, GA 30310-2750
Phone (404) 752-1400

Other identifiers 1

IdentifierTypeStateIssuer
000352811AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040701000830 GA Practitioner - Internal Medicine 1951205681 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
029420GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Family Health Centers of Georgia, Inc Current Accepting new patients
The Family Health Centers of Georgia, Inc CurrentSince Oct 3, 2010 Accepting new patients
The Family Health Centers of Georgia, Inc CurrentSince Jun 1, 2009 Accepting new patients
Friendship Community Healthcare Inc Past Accepting new patients

Locations

868 York Ave SW
Atlanta, GA 30310

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Family Health Centers of Georgia, IncAtlanta, GA, CCN 111810 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jun 1, 2011
Jun 1, 2011
The Family Health Center @ CobbMarietta, GA, CCN 111939 Federally qualified health center 5% Or Greater Indirect Ownership Interest
W-2 Managing Employee		 Aug 1, 2010
Jun 1, 2009
Georgia Center for WomenAtlanta, GA, CCN 851929 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 1, 2009
Jun 1, 2009
The Family Health Centers of Georgia, IncMorrow, GA, CCN 851846 Federally qualified health center 5% Or Greater Indirect Ownership Interest
W-2 Managing Employee		 Jun 1, 2009
Jun 1, 2009
McDonough Children'S SpecialistMcDonough, GA, CCN C21031 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 1, 2009
Jun 1, 2009

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1174513089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "868 YORK AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303102750",
            "telephone_number": "404-752-1400",
            "fax_number": "404-758-0740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "868 YORK AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303102750",
            "telephone_number": "404-752-1400",
            "fax_number": "404-758-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "GA",
            "license": "029420",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "029420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000352811A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.