Pavan Kumar Mamilla, M.D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

79227 Issued in GA

Practice address

11379 Southbridge Pkwy Ste a
Alpharetta, GA 30022-4402

Phone

(770) 777-0750

Fax

(770) 777-0521

NPI assigned

Jul 29, 2009

Last updated

Nov 2, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Metro Medical Associates LLCGroup PAC ID 2567568603, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• Emory Johns Creek Hospital Hospital, Johns Creek, GA, CCN 110230

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Metro Medical Associates LLC

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1982619789
  Medicare reassignment Care Compare group NPD
• University of Alabama at Birmingham

  dba UAB Health Center Montgomery

  • Internal Medicine Physician
  • Montgomery, AL
  • NPI 1184738478
  Medicare reassignment NPD
• University of Alabama at Birmingham

  dba UAB Selma Family Medicine

  • Family Medicine Physician
  • Selma, AL
  • NPI 1144235870
  NPD
• University of Alabama at Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1447145818
  NPD
• Metro Medical Associates of Decatur, LLC

  • Adult Medicine Physician
  • Decatur, GA
  • NPI 1043526114
  NPD (past)
• Mount Lassen Emergency Physicians LLC

  • Emergency Medicine Physician
  • Cartersville, GA
  • NPI 1730598590
  NPD (past)
• Apogee Medical Group Tennessee PC

  • General Practice Physician
  • Scottsdale, AZ
  • NPI 1578717682
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ehca Johns Creek, LLC

  dba Emory Johns Creek Hospital

  • General Acute Care Hospital
  • Johns Creek, GA
  • NPI 1679632137
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1417188103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11379 SOUTHBRIDGE PKWY STE A",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224402",
            "telephone_number": "770-777-0750",
            "fax_number": "770-777-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11379 SOUTHBRIDGE PKWY STE A",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224402",
            "telephone_number": "770-777-0750",
            "fax_number": "770-777-0521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMILLA",
        "first_name": "PAVAN KUMAR",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-29",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "MD.33421",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "79227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Louis Mallamace, DC
• Marissa Malloy
• Jacqueline Michelle Malone, DMD, MS
• Danya Maloon, LMSW
• Mariann Mamberg, MSW,LCSW
• Charmaine Claudine Manalo
• Meredith Kenny Maneira, SLP
• Kiley Elizabeth Manetta, D.O.
• Navdeep Mangat, MD
• Mankind Holdings, LLC (ComForCare Home Care)

• Family Medicine Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.