Individual provider Active NPI

Jeanette Dormio, FNP-BC

  • Primary Care Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1427561836
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN240821 Issued in GA
Practice address
1655 Lebanon Rd Ste a
Lawrenceville, GA 30043-5116
Phone
(770) 682-2024
NPI assigned
Nov 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN240821 GA Primary

Addresses

Primary practice location

1655 Lebanon Rd Ste a
Lawrenceville, GA 30043-5116

Mailing address

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180719003485 GA Practitioner - Nurse Practitioner 9234486309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Professional Services LLCGroup PAC ID 0840291944, 423 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (770) 255-7500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN240821GAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC CurrentSince Jan 16, 2018 Accepting new patients
North Atlanta Professional Services LLC CurrentSince Jul 1, 2024 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince Jan 16, 2018 Accepting new patients

Locations

3620 Howell Ferry Rd
Duluth, GA 30096
Phone (678) 312-3294

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

1655 Lebanon Rd
Ste A
Lawrenceville, GA 30043
Phone (770) 682-2024

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1427561836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 LEBANON RD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435116",
            "telephone_number": "770-682-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMIO",
        "first_name": "JEANETTE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-07",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN240821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.