Patriot Healthcare of Georgia, LLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

PATRIOT HEALTHCARE OF GEORGIA, LLC

Doing business as

PHC of GA College Park

Practice address

1587 Phoenix Boulevard
Suite 6
College Park, GA 30349

Phone

(404) 435-6029

NPI assigned

Nov 15, 2018

Last updated

Nov 15, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David A. Culver

Title

Administrator

Phone

(904) 825-4368

Specialties & licenses 1

Addresses

Other names 1

• PHC of GA College Park Doing business as

Tax ID family

Patriot Healthcare of Georgia LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Patriot Healthcare of Georgia, LLC

  dba PHC of GA Stone Mountain

  • Geriatric Medicine (Family Medicine) Physician
  • Stone Mountain, GA
  • NPI 1558830919
  NPD tax ID

Locations

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1275002636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVENUE",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-825-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1587 PHOENIX BOULEVARD",
            "address_2": "SUITE 6",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "30349",
            "telephone_number": "404-435-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT HEALTHCARE OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "CULVER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-825-4368"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC of GA College Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Geriatric Medicine (Family Medicine) Physician in College Park, GA
• Providers in College Park, GA by specialty
• Geriatric Medicine (Family Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; 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.