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

Last updated

Feb 26, 2020By 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

Maureen Clancy

Title

Senior Vice President

Phone

(571) 366-8845

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

Tax ID family

Privia Medical Group 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.

• Privia Medical Group of Georgia LLC

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

Locations (25 of 32)

Practitioners 823

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.

• William Clint Adcox, MD

  • Family Medicine Physician
  • Fayetteville, GA
  • NPI 1124086350
  NPD
• Michelle Adegbemle, FNP

  • Family Nurse Practitioner
  • Fayetteville, GA
  • NPI 1134809809
  NPD
• Lawrence Adjetey Adjei, MD

  • Internal Medicine Physician
  • Rincon, GA
  • NPI 1689637134
  NPD
• Latifat Tosin Agbeja, M.D

  • Family Medicine Physician
  • Albany, GA
  • NPI 1356575054
  NPD
• Susan Ahle

  • Acute Care Nurse Practitioner
  • Savannah, GA
  • NPI 1649646688
  NPD
• Shelley Albertson, FNP

  • Nurse Practitioner
  • Fayetteville, GA
  • NPI 1952012692

  Family Medicine

  NPD
• Casey Allen, AUD

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

  • Family Medicine Physician
  • Newnan, GA
  • NPI 1588619530
  NPD
• David Lloyd Anders, M.D.

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

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

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

  • Psychiatric/Mental Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1407594757
  NPD

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

• Pritzker Dermatology, P.C. (Savannah Dermatology Clinic, 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 (ProCare Wellness Institute of Savannah)
• Alexis Proctor, LCSW
• Sean Jason Proctor, PT
• Professional Optical Services
• Professional Optical Services

• Internal Medicine Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• 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.