NPIMap

Organization Active NPI

Medprime, LLC

  • General Practice Physician
  • Atlanta, GA
National Provider Identifier
1245519636
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
044023 Issued in GA
Legal business name
MEDPRIME, LLC
Practice address
1197 Peachtee Street NE
Atlanta, GA 31150
Phone
(404) 522-5552
Fax
(404) 522-5151
NPI assigned
Aug 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

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

Authorized official

Name
Mark Reznik
Title
Practice Administrator
Phone
(770) 652-3667

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CHIRO07312 GA
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 044023 GA Primary

Addresses

Primary practice location

1197 Peachtee Street NE
Atlanta, GA 31150

Mailing address

PO Box 501741
Atlanta, GA 31150-1741
Phone (404) 522-5552

Other names 1

  • Wellness Plus Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medprime LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1197 Peachtree St NE
Atlanta, GA 30361
Phone (404) 522-5552

NPI Registry JSON

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1245519636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 501741",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311501741",
            "telephone_number": "404-522-5552",
            "fax_number": "404-522-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1197 PEACHTEE STREET NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "31150",
            "telephone_number": "404-522-5552",
            "fax_number": "404-522-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPRIME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-08-16",
        "status": "A",
        "authorized_official_last_name": "REZNIK",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-652-3667"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIRO07312",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "044023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Plus Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 16, 2011; 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.