Phynova Mso, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PHYNOVA MSO, LLC

Practice address

1718 Peachtree St NW Ste 380
Atlanta, GA 30309-2498

Phone

(770) 270-5229

Fax

(770) 270-9323

NPI assigned

Aug 10, 2020

Organization subpart

Yes

Parent organization

PMR HOLDING COMPANY, LLCAs reported in NPPES

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

Authorized official

Name

Laverne W Poindexter

Title

Chief Executive Officer

Phone

(770) 270-5229

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Marquitha S Mayfield, PAC

  • Surgical Physician Assistant
  • Atlanta, GA
  • NPI 1134443054
  NPD (past)

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1447861950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54157",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303080157",
            "telephone_number": "770-270-5229",
            "fax_number": "770-270-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 PEACHTREE ST NW STE 380",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303092498",
            "telephone_number": "770-270-5229",
            "fax_number": "770-270-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYNOVA MSO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PMR HOLDING COMPANY, LLC",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A",
        "authorized_official_last_name": "POINDEXTER",
        "authorized_official_first_name": "LAVERNE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "770-270-5229"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phyllis Carrera
• Phyllis Williams, LMFT, PC
• Physical Therapy Inc
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• Physician Pain Specialists, P.C.
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• Physician Specialists of Atlanta

• Specialist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.