Phoenix Medical Office at College Park,LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

39813 Issued in GA

Legal business name

PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC

Practice address

1631 Phoenix Blvd Ste 4
College Park, GA 30349-5545

Phone

(678) 788-8950

Fax

(678) 788-8953

NPI assigned

Jul 15, 2011

Organization subpart

No

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

Authorized official

Name

Kelvin Maurice Hamner, MDNPI 1073656344

Title

Owner/MD

Phone

(678) 788-8950

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Kelvin Hamner, M.D.

  • Internal Medicine Physician
  • College Park, GA
  • NPI 1073656344
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1396033064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 PHOENIX BLVD STE 4",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495545",
            "telephone_number": "678-788-8950",
            "fax_number": "678-788-8953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 PHOENIX BLVD STE 4",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495545",
            "telephone_number": "678-788-8950",
            "fax_number": "678-788-8953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-15",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "HAMNER",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_middle_name": "MAURICE",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "678-788-8950",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "39813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tedra Perkins, LMFT
• Felicia R Perry, LPC
• Personal Quality Private Duty Sitting Services LLLP
• Phenix Community Care Group, LLC
• Nicole Regina Phifer, MA,ST, BA
• Phoenix Women'S Center, P.C.
• Physiotherapy Associates Inc
• Gabrielle Pointer
• Polaris Spine & Neurosurgery Center PC
• Positive Impact HHS, Inc.

• Internal Medicine Physician in College Park, GA
• Providers in College Park, 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 Dec 11, 2012; 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.