NPIMap

Organization Active NPI

Long's Drugs of Sandersville, Georgia, Inc.

Doing business as AvitaCare

  • Infectious Disease Physician
  • Atlanta, GA
National Provider Identifier
1265155774
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
Doing business as
AvitaCare
Practice address
2140 Peachtree Rd NW Ste 232
Atlanta, GA 30309-1316
Phone
(404) 231-4431
NPI assigned
Sep 20, 2022
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Ashley Ellis
Title
Corporate Counsel
Phone
(704) 641-7967

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

2140 Peachtree Rd NW Ste 232
Atlanta, GA 30309-1316

Mailing address

5700 Granite Pkwy Ste 425
Plano, TX 75024-6648

Other names 1

  • AvitaCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221206001542 GA Part B Supplier - Clinic/Group Practice 4385969609 Receives reassigned benefits from 19 practitioners
Practice locations: Atlanta, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Long's Drugs of Sandersville Ga Inc

Locations

2140 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 351-4114

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1265155774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 GRANITE PKWY STE 425",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 PEACHTREE RD NW STE 232",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091316",
            "telephone_number": "404-231-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "704-641-7967"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AvitaCare",
            "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 Sep 20, 2022; 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.