NPIMap

Organization Active NPI

Reinvent Your Identity,LLC

  • Clinic/Center
  • McDonough, GA
National Provider Identifier
1235871013
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
REINVENT YOUR IDENTITY,LLC
Practice address
4403 Kady CT
McDonough, GA 30252-3700
Phone
(404) 644-4198
NPI assigned
Apr 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Abidemi MarshNPI 1346982121
Title
Owner
Phone
(404) 644-4198

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Corporate Health Clinic/Center 261QC1800X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Student Health Clinic/Center 261QS1000X

Addresses

Primary practice location

4403 Kady CT
McDonough, GA 30252-3700

Mailing address

4403 Kady CT
McDonough, GA 30252-3700

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": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1235871013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 KADY CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 KADY CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523700",
            "telephone_number": "404-644-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REINVENT YOUR IDENTITY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "ABIDEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-644-4198"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.