NPIMap

Organization Active NPI

Intown Family Practice & Sports Medicine PC

  • Primary Care Clinic/Center
  • Atlanta, GA
National Provider Identifier
1235446394
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
038777 Issued in GA
Legal business name
INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC
Practice address
285 Boulevard Ave NE
Suite 640
Atlanta, GA 30312-4212
Phone
(404) 577-7800
Fax
(404) 577-7810
NPI assigned
Sep 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

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

Authorized official

Name
Lawrence Leo Golusinski Jr., M.D.
Title
Owner
Phone
(404) 577-7800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 038777 GA Primary
Primary Care Clinic/Center 261QP2300X 20330 NC

Addresses

Primary practice location

285 Boulevard Ave NE
Suite 640
Atlanta, GA 30312-4212

Mailing address

285 Boulevard Ave NE
Suite 640
Atlanta, GA 30312-4212
Phone (404) 577-7800

Other identifiers 6

IdentifierTypeStateIssuer
160928OtherGACOVENTRY HEALTHCARE
52476640002OtherGABCBS OF GA
0191191OtherGAUNITED HEALTHCARE
4546534OtherGAAETNA
1013698006OtherGACIGNA HEALTHCARE
776894OtherGAFIRST HEALTH

National Provider Directory

National Provider Directory

Locations

285 Boulevard NE
Ste 640
Atlanta, GA 30312
Phone (404) 577-7800

NPI Registry JSON

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

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1235446394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 BOULEVARD AVE NE",
            "address_2": "SUITE 640",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303124212",
            "telephone_number": "404-577-7800",
            "fax_number": "404-577-7810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 BOULEVARD AVE NE",
            "address_2": "SUITE 640",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303124212",
            "telephone_number": "404-577-7800",
            "fax_number": "404-577-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-09",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "GOLUSINSKI",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "LEO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-577-7800",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "038777",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "20330",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTHCARE",
            "identifier": "160928",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GA",
            "identifier": "52476640002",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0191191",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4546534",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "1013698006",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "776894",
            "state": "GA"
        }
    ],
    "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 Sep 9, 2010; 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.