South Fulton Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

046202 Issued in GA

Legal business name

SOUTH FULTON PRIMARY CARE, LLC

Practice address

1203 Cleveland Ave
Suite 1a
East Point, GA 30344-3417

Phone

(404) 305-8900

Fax

(404) 305-8099

NPI assigned

Dec 4, 2009

Organization subpart

No

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

Authorized official

Name

Logan Allen

Title

VP Client Operations

Phone

(678) 252-2137

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259884800000",
    "number": "1174851919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 WISTERIA DR",
            "address_2": "SUITE 208",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782656",
            "telephone_number": "678-252-2137",
            "fax_number": "678-336-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 CLEVELAND AVE",
            "address_2": "SUITE 1A",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443417",
            "telephone_number": "404-305-8900",
            "fax_number": "404-305-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FULTON PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-04",
        "last_updated": "2009-12-04",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "VP CLIENT OPERATIONS",
        "authorized_official_telephone_number": "678-252-2137"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "046202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Atlanta Medical Associates, PC
• South Atlanta Pulmonary Group
• South Atlanta Spine and Wellness Center
• South Fulton Dermatology Associates,LLP
• South Fulton Medical Center Practice Plan, LLC (South Fulton Medical Center Practice Plan)
• South Fulton Regional Medical Center Pro Fee Billing, LLC
• South Mental Health
• Southcare Physicians Group Surgical Specialists, LLC
• Southern International Living, Inc
• Southside Associates OB/GYN, Inc

• Family Medicine Physician in East Point, GA
• Providers in East Point, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.