NPIMap

Organization Active NPI

Medprime, LLC

Doing business as Wellness Plus Clinic

  • General Practice Physician
  • Atlanta, GA
National Provider Identifier
1265711634
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
Doing business as
Wellness Plus Clinic
Practice address
3 Ravinia Dr
Suite P-160
Atlanta, GA 30346-2118
Phone
(770) 392-7160
Fax
(770) 392-7163
NPI assigned
Aug 16, 2011
Last updated
Aug 16, 2011By the provider in NPPES
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) 392-7160

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

3 Ravinia Dr
Suite P-160
Atlanta, GA 30346-2118

Mailing address

PO Box 501741
Atlanta, GA 31150-1741
Phone (770) 392-7160

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

3 Ravinia Dr
Ste P160
Atlanta, GA 30346
Phone (770) 392-7160

Practitioners & affiliated clinicians

Practitioners 2

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": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1265711634",
    "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": "770-392-7160",
            "fax_number": "770-392-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RAVINIA DR",
            "address_2": "SUITE P-160",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303462118",
            "telephone_number": "770-392-7160",
            "fax_number": "770-392-7163"
        }
    ],
    "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": "770-392-7160"
    },
    "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.