NPIMap

Organization Active NPI

Dekalb Family Practice, P.C.

  • Family Medicine Physician
  • Stone Mountain, GA
National Provider Identifier
1255584744
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
030034 Issued in GA
Legal business name
DEKALB FAMILY PRACTICE, P.C.
Practice address
5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239
Phone
(404) 292-5676
Fax
(404) 299-8657
NPI assigned
Oct 28, 2008
Last updated
Oct 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Dr. Edward Alvin Corkran, D.O.NPI 1174559140
Title
President
Phone
(404) 292-5676

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 030034 GA Primary

Addresses

Primary practice location

5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239

Mailing address

5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239
Phone (404) 292-5676

National Provider Directory

National Provider Directory

Locations

5462 Memorial Dr
Ste 202
Stone Mtn, GA 30083
Phone (404) 292-4057

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1255584744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5462 MEMORIAL DR",
            "address_2": "SUITE 202",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833239",
            "telephone_number": "404-292-5676",
            "fax_number": "404-299-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5462 MEMORIAL DR",
            "address_2": "SUITE 202",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833239",
            "telephone_number": "404-292-5676",
            "fax_number": "404-299-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB FAMILY PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "CORKRAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-292-5676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "030034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.