Med-South Primary Care

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

047830 Issued in GA

Legal business name

MED-SOUTH PRIMARY CARE

Practice address

1240 Eagles Landing Parkway
Suite 100
Stockbridge, GA 30281

Phone

(770) 506-0100

Fax

(770) 507-2597

NPI assigned

Dec 7, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Marie Padgett

Title

Insurance Coordinator

Phone

(770) 506-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MED-SOUTH PRIMARY CARE Former legal business name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Ira Charles Robinson II, M.D.

  • Internal Medicine Physician
  • Stockbridge, GA
  • NPI 1174615116
  Medicare reassignment NPD
• Montrese Pitmon Alleyne, NP-C

  • Family Nurse Practitioner
  • Stockbridge, GA
  • NPI 1346593852
  NPD (past)
• Syed Sajid Hasan, MD

  • Neurology Physician
  • Riverdale, GA
  • NPI 1972605418
  NPD (past)

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1245413715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 EAGLES LANDING PARKWAY",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-506-0100",
            "fax_number": "770-507-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 EAGLES LANDING PARKWAY",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-506-0100",
            "fax_number": "770-507-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-SOUTH PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "PADGETT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "770-506-0100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "047830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00932357A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MED-SOUTH PRIMARY CARE",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nashon Ijunaya McPherson
• Christina Anne McQueen, PMHNP
• Desha McWilliams
• Ryan Meacham, PA-AA
• Med Path Professional Services, Inc.
• Emily Caroline Medendorp, DMD
• Medex of Georgia Inc
• Medical Escort LLC
• Medicine Pointe Pharmacy LLC
• Miles Anthony Medina, D.O.

• Internal Medicine Physician in Stockbridge, GA
• Providers in Stockbridge, 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 Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.