Tristar Injury Center of Decatur LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRISTAR INJURY CENTER OF DECATUR LLC

Practice address

2417 Candler Rd
Decatur, GA 30032-6410

Phone

(678) 730-6240

NPI assigned

Mar 24, 2022

Last updated

Mar 24, 2022By 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

Alex Jutis, DC

Title

Owner

Phone

(678) 730-6240

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1396495206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3441 LAWRENCEVILLE SUWANEE RD STE C",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246503",
            "telephone_number": "678-730-6240",
            "fax_number": "678-730-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2417 CANDLER RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300326410",
            "telephone_number": "678-730-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTAR INJURY CENTER OF DECATUR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "JUTIS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-730-6240",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Decatur, GA
• Providers in Decatur, 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 Mar 24, 2022; 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.