Old National Primary Care Clinic, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

066254 Issued in GA

Legal business name

OLD NATIONAL PRIMARY CARE CLINIC, LLC

Practice address

5185 Old National Hwy
Atlanta, GA 30349-3244

Phone

(404) 763-9300

Fax

(404) 763-9306

NPI assigned

Oct 26, 2011

Organization subpart

No

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

Authorized official

Name

Eva Isabelle Beaulieu, M.D.NPI 1366603557

Title

Owner

Phone

(786) 556-0495

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Eva Isabelle Beaulieu, MD

  • Internal Medicine Physician
  • Stockbridge, GA
  • NPI 1366603557
  NPD (past) Authorized official

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1376829028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 JODECO RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814953",
            "telephone_number": "678-284-6300",
            "fax_number": "678-284-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5185 OLD NATIONAL HWY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303493244",
            "telephone_number": "404-763-9300",
            "fax_number": "404-763-9306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD NATIONAL PRIMARY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-26",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "BEAULIEU",
        "authorized_official_first_name": "EVA",
        "authorized_official_middle_name": "ISABELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-556-0495",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "066254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olubunmi Olasele
• Augusta H Olatidoye, LPC
• Adedeji Olatoto, NP
• Comfort Olawoyin
• Adegboyega Olaseni Olayode, MBBS
• Bianca Kaitlyn Oldershaw, D.C.
• Nicole S Olds, PAAA
• Noelle Yaeger Oleary, MPH, RD, LD
• Anne Olesen, P.A.
• Jeanine Oliga, MD

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, 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 May 10, 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.