Privia Medical Group of Georgia LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIVIA MEDICAL GROUP OF GEORGIA LLC

Practice address

1326 Eisenhower Dr BLDG 1
Savannah, GA 31406-3928

Phone

(571) 366-8850

NPI assigned

May 16, 2019

Organization subpart

No

Name

Maureen Clancy

Title

Senior Vice President

Phone

(571) 366-8845

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857

  4284951542

  Same PAC ID

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

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1164052189
  NPD tax ID

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

• William Clint Adcox, MD

  • Family Medicine Physician
  • Fayetteville, GA
  • NPI 1124086350

  Family Medicine

  Care Compare group NPD
• Lawrence Adjetey Adjei, MD

  • Internal Medicine Physician
  • Rincon, GA
  • NPI 1689637134

  Internal Medicine

  Care Compare group NPD
• Latifat Tosin Agbeja, M.D

  • Family Medicine Physician
  • Albany, GA
  • NPI 1356575054

  Family Medicine

  Care Compare group NPD
• Shelley Albertson, FNP

  • Nurse Practitioner
  • Fayetteville, GA
  • NPI 1952012692

  Family Medicine

  Care Compare group NPD
• Casey Allen, AUD

  • Audiologist
  • Savannah, GA
  • NPI 1720518467
  Care Compare group NPD
• Jorge A Amador, MD

  • Family Medicine Physician
  • Newnan, GA
  • NPI 1588619530

  Family Medicine

  Care Compare group NPD
• David Lloyd Anders, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Peachtree City, GA
  • NPI 1689666984
  Care Compare group NPD
• Mark Anderson, NP-C

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1386112456
  Care Compare group NPD
• Paul Duane Anderson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1427654508
  Care Compare group NPD
• Chiamaka Joyce Anosike, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1407594757
  Care Compare group NPD
• Prentiss Rachel Autry, MD

  • Family Medicine Physician
  • Albany, GA
  • NPI 1457939225

  Family Medicine

  Care Compare group NPD
• Nenad Risto Avramovski, M.D.

  • Infectious Disease Physician
  • Savannah, GA
  • NPI 1760480701
  Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Privia Medical GRP of Ga (2 organizations share this tax ID)

Locations (25 of 34)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 26, 2020.

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1356907273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 4000",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031824",
            "telephone_number": "571-366-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 EISENHOWER DR BLDG 1",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063928",
            "telephone_number": "571-366-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-16",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "CLANCY",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "571-366-8845"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "7787550001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pritzker Dermatology, P.C.
• Adam Scott Pritzker, M.D.
• Martin S. Pritzker, M.D.
• Private Healthcare Facilities
• Privia Medical Group of Georgia LLC
• Procare Wellness Network Inc
• Alexis Proctor, LCSW
• Sean Jason Proctor, PT
• Professional Optical Services
• Professional Optical Services

• All providers in Savannah, GA
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.