NPIMap

Organization Active NPI

Preventive Medicine & Anti-Aging Institute LLC

  • Point of Service
  • Sandy Springs, GA
National Provider Identifier
1326307513
Registry record updated May 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
MD046372 Issued in GA
Legal business name
PREVENTIVE MEDICINE & ANTI-AGING INSTITUTE LLC
Practice address
171 Mount Paran Rd.
Sandy Springs, GA 30342-2211
Phone
(770) 451-4857
Fax
(678) 705-5767
NPI assigned
May 9, 2012
Last updated
May 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2012

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

Authorized official

Name
Robert A Burkich, MDNPI 1811936891
Title
Owner
Phone
(770) 451-4857

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X MD046372 GA Primary

Addresses

Primary practice location

171 Mount Paran Rd.
Sandy Springs, GA 30342-2211

Mailing address

171 Mount Paran Rd.
Sandy Springs, GA 30342-2211
Phone (770) 451-4857

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1326307513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 MOUNT PARAN RD.",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303422211",
            "telephone_number": "770-451-4857",
            "fax_number": "678-705-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 MOUNT PARAN RD.",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303422211",
            "telephone_number": "770-451-4857",
            "fax_number": "678-705-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICINE & ANTI-AGING INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "BURKICH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-451-4857",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": "MD046372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; 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.