NPIMap

St. Mary'S Medical Group, Inc.

Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Athens, GA

NPI 1316733355 · NPPES record last updated Apr 16, 2025

Key facts

NPI
1316733355
Entity type
Organization (NPI type 2)
Primary specialty
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
Legal business name
ST. MARY'S MEDICAL GROUP, INC.
Practice address
1230 Baxter St
Athens, GA 30606-3712
Phone
(706) 389-3000
Fax
(706) 389-3951
NPI assigned
Apr 16, 2025
Organization subpart
No

Authorized official

Name
Brittainy Horne
Title
President
Phone
(706) 389-3940

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

Corporate family (same tax ID) 14

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 133

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 133

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080616000388 GA Part B Supplier - Clinic/Group Practice 7113098393 Receives reassigned benefits from 126 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, GA; Bogart, GA; Greensboro, GA; Lavonia, GA; Monroe, GA; Watkinsville, GA

National Provider Directory

Tax ID family
St Mary'S Medical Group Inc (15 organizations share this tax ID)

Locations

1500 Oglethorpe Ave
Ste 400A
Athens, GA 30606
Phone (706) 548-8600

2470 Daniells Bridge Rd
Ste 300
Athens, GA 30606
Phone (706) 389-2075

700 Sunset Dr
Ste 302
Athens, GA 30606
Phone (706) 548-9111

355 Clear Creek Pkwy
Ste 1003
Lavonia, GA 30553
Phone (706) 356-1422

355 Clear Creek Pkwy
Ste 2004
Lavonia, GA 30553
Phone (706) 356-0554

1020 Jamestown Blvd
#200
Watkinsville, GA 30677
Phone (706) 769-0005

1181 Langford Dr
Ste 103
Watkinsville, GA 30677
Phone (706) 389-3880

1360 Caduceus Way
Bldg 200-102
Watkinsville, GA 30677
Phone (706) 389-3810

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207ZP0102X Yes

Addresses

Primary practice location

1230 Baxter St
Athens, GA 30606-3712

Mailing address

PO Box 48089
Athens, GA 30604-8089
Phone (706) 389-3740

Other names

  • ST. MARY'S PATHOLOGY SPECIALISTS Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 16, 2025.

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1316733355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48089",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306048089",
            "telephone_number": "706-389-3740",
            "fax_number": "706-389-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 BAXTER ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063712",
            "telephone_number": "706-389-3000",
            "fax_number": "706-389-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "BRITTAINY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-389-3940"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. MARY'S PATHOLOGY SPECIALISTS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Athens, GA

All providers in Athens, GA · Anatomic Pathology & Clinical Pathology Physician in Georgia

Sources for this page

Verify at the official NPI Registry.