Medprime Brookhaven

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

61430 Issued in GA

Legal business name

MEDPRIME BROOKHAVEN

Practice address

2 Concourse Pkwy
Suite 100
Atlanta, GA 30328-5371

Phone

(678) 691-8239

NPI assigned

Jul 4, 2016

Organization subpart

No

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

Authorized official

Name

Sherwin Eugene Bryant, MHA

Title

Compliance Officer

Phone

(678) 691-8239

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1467590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467590400000",
    "number": "1205288164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PEACHTREE ST NE",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303094501",
            "telephone_number": "678-691-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CONCOURSE PKWY",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285371",
            "telephone_number": "678-691-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPRIME BROOKHAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-04",
        "last_updated": "2016-07-04",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "SHERWIN",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "678-691-8239",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "GA",
            "license": "61430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Danelle Medlin, CPNP
• Lisa Medlin
• Sar Medoff, M.D.
• Medprime, LLC (Wellness Plus Clinic)
• Medprime, LLC (Wellness Plus Clinic)
• Medprime, LLC (Wellness Plus Clinic)
• Medprime, LLC (Wellness Plus Clinic)
• Medqits L.L.C

• Preferred Provider Organization in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Preferred Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2016; 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.