The Southeast Permanente Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

THE SOUTHEAST PERMANENTE MEDICAL GROUP

Practice address

3495 Piedmont Road NE
Nine Piedmont Center
Atlanta, GA 30305-1773

Phone

(404) 364-3821

NPI assigned

Jun 24, 2006

Last updated

Jul 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael DohertyNPI 1770659328

Title

Associate Medical Director

Phone

(404) 364-2245

Specialties & licenses 15

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1,556

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael F Doherty, MD

  • Hematology & Oncology Physician
  • Jonesboro, GA
  • NPI 1770659328
  Medicare reassignment Care Compare group NPD Authorized official
• Mohammed Y Abubaker, MD

  • Rheumatology Physician
  • Marietta, GA
  • NPI 1396733796

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Nimota A Adeboye, NP

  • Women's Health Nurse Practitioner
  • Atlanta, GA
  • NPI 1235108176
  Medicare reassignment Care Compare group NPD
• Kenneth K Aden, MD

  • Otolaryngology Physician
  • Atlanta, GA
  • NPI 1447353818
  Medicare reassignment Care Compare group NPD
• Dina Adimora-Onwuka

  • Hospitalist Physician
  • Atlanta, GA
  • NPI 1568780252

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Ifeyinwa A Adimorah, MD

  • Internal Medicine Physician
  • Duluth, GA
  • NPI 1437289907
  Medicare reassignment Care Compare group NPD
• Caroline Pilgrim Adobah, P.A.

  • Physician Assistant
  • Cumming, GA
  • NPI 1639598105
  Medicare reassignment Care Compare group NPD
• Sandra Umuko Yerakpo Agoreyo, FNP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1568146173
  Medicare reassignment Care Compare group NPD
• Monica Agrawal

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1992907018
  Medicare reassignment Care Compare group NPD
• Uchenna E Aguwa, DO

  • Emergency Medicine Physician
  • Jonesboro, GA
  • NPI 1164625950
  Medicare reassignment Care Compare group NPD
• Seeme V Ahmad, MD

  • Psychiatry Physician
  • Jonesboro, GA
  • NPI 1306943394
  Medicare reassignment Care Compare group NPD
• Shelly J Ahmann, MD

  • Surgery Physician
  • Atlanta, GA
  • NPI 1104935048
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500336000000",
    "number": "1245266956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051773",
            "telephone_number": "404-364-3821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051773",
            "telephone_number": "404-364-3821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTHEAST PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2017-07-18",
        "status": "A",
        "authorized_official_last_name": "DOHERTY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSOCIATE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-364-2245",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.