Covenant Family Medicine GMG LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COVENANT FAMILY MEDICINE GMG LLC

Practice address

2098 Teron Trce
Suite 150
Dacula, GA 30019-1663

Phone

(678) 730-1620

NPI assigned

Jul 17, 2012

Last updated

Aug 23, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

GWINNETT MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Mr. Steven A Rubin

Title

Executive Director

Phone

(470) 325-0150

Specialties & licenses 1

Addresses

Part of

Gwinnett Medical SVC Inc

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Gwinnett Medical Group, Inc

  • General Practice Physician
  • Lawrenceville, GA
  • NPI 1780747469
  NPPES parent name

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1346595204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2069 TERON TRCE",
            "address_2": "SUITE 100",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191665",
            "telephone_number": "678-730-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2098 TERON TRCE",
            "address_2": "SUITE 150",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191663",
            "telephone_number": "678-730-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT FAMILY MEDICINE GMG LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GWINNETT MEDICAL GROUP",
        "enumeration_date": "2012-07-17",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "RUBIN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "470-325-0150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Davidson Corley, M.D.
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• Cornerstone Family Practice, P.C.
• Cornerstone Pediatrics LLC
• Covenant Family Medicine
• Darrcelle S Covert
• Whitney Nicole Cox, RBT
• Jessica Cranford, MS,CCC-SLP
• Creative Case Management Services LLC
• Cayla C Crewey, OTR/L

• Family Medicine Physician in Dacula, GA
• Providers in Dacula, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.