Active NPI
Kimberly A Serravezza, MD
- Sports Medicine (Psychiatry & Neurology) Physician
- Atlanta, GA
National Provider Identifier
1235130626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Psychiatry & Neurology) Physician
- License
- 052048
- Practice address
- 4 Executive Park East NE
Suite 470
Atlanta, GA 30329-2245 - Phone
- (404) 327-9682
- NPI assigned
- Aug 9, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Psychiatry & Neurology) Physician | 2084S0010X | 052048 | GA | Primary |
Addresses
Primary practice location
4 Executive Park East NE
Suite 470
Atlanta, GA 30329-2245
Mailing address
4 Executive Park East NE
Suite 470
Atlanta, GA 30329-2245
Phone (404) 327-9682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 28, 2015 through Oct 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052048 | GA | MD | Sports Medicine (Psychiatry & Neurology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235433600000",
"number": "1235130626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 EXECUTIVE PARK EAST NE",
"address_2": "SUITE 470",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292245",
"telephone_number": "404-327-9682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 EXECUTIVE PARK EAST NE",
"address_2": "SUITE 470",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292245",
"telephone_number": "404-327-9682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRAVEZZA",
"first_name": "KIMBERLY",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-09",
"last_updated": "2009-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084S0010X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Sports Medicine",
"state": "GA",
"license": "052048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.