NPIMap

Organization Active NPI

Procare Medical Group, LLC

  • Physical Medicine & Rehabilitation Physician
  • Marietta, GA
National Provider Identifier
1194128447
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
PROCARE MEDICAL GROUP, LLC
Practice address
1395 S Marietta Pkwy SE
BLDG 100 Suite 102
Marietta, GA 30067-4440
Phone
(770) 425-8700
Fax
(770) 425-8740
NPI assigned
Oct 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Cynthia Tate
Title
Administrator
Phone
(770) 428-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X GA Primary

Addresses

Primary practice location

1395 S Marietta Pkwy SE
BLDG 100 Suite 102
Marietta, GA 30067-4440

Mailing address

1395 S Marietta Pkwy SE
BLDG 100 Suite 102
Marietta, GA 30067-4440
Phone (770) 425-8700

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1194128447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 S MARIETTA PKWY SE",
            "address_2": "BLDG 100 SUITE 102",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "770-425-8700",
            "fax_number": "770-425-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 S MARIETTA PKWY SE",
            "address_2": "BLDG 100 SUITE 102",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "770-425-8700",
            "fax_number": "770-425-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-428-8700"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.