NPIMap

Organization Active NPI

Pristine Healthcare

  • Health Service Clinic/Center
  • Villa Rica, GA
National Provider Identifier
1225477102
Registry record updated Jun 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
057975 Issued in GA
Legal business name
PRISTINE HEALTHCARE
Practice address
5000 Serenity Point LN
Villa Rica, GA 30180-6963
Phone
(404) 580-7642
NPI assigned
Jun 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2013

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

Authorized official

Name
Dr. Michael Anthony Gibson, M.D.NPI 1750589891
Title
Owner
Phone
(404) 580-7642

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 057975 GA Primary

Addresses

Primary practice location

5000 Serenity Point LN
Villa Rica, GA 30180-6963

Mailing address

5000 Serenity Point LN
Villa Rica, GA 30180-6963
Phone (404) 580-7642

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372032000000",
    "number": "1225477102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 SERENITY POINT LN",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301806963",
            "telephone_number": "404-580-7642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SERENITY POINT LN",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301806963",
            "telephone_number": "404-580-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2013-06-24",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-580-7642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "057975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; 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.