NPIMap

Organization Active NPI

PMC Medical & Diagnostics, LLC

  • General Practice Physician
  • Atlanta, GA
National Provider Identifier
1457692956
Registry record updated Mar 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
026769 Issued in GA
Legal business name
PMC MEDICAL & DIAGNOSTICS, LLC
Practice address
4646 N Shallowford Rd Ste 100
Atlanta, GA 30338-6308
Phone
(770) 392-9805
NPI assigned
Mar 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2013

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

Authorized official

Name
Mrs. Mary Leach
Title
Team Finance Leader
Phone
(678) 736-6342

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 026769 GA Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 038861 GA

Addresses

Primary practice location

4646 N Shallowford Rd Ste 100
Atlanta, GA 30338-6308

Mailing address

4646 N Shallowford Rd Ste 100
Atlanta, GA 30338-6308
Phone (770) 392-9805

National Provider Directory

National Provider Directory
Tax ID family
PMC Medical Diagnostics LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4646 N Shallowford Rd
Ste 100
Atlanta, GA 30338
Phone (770) 392-9805

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1457692956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N SHALLOWFORD RD STE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386308",
            "telephone_number": "770-392-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N SHALLOWFORD RD STE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386308",
            "telephone_number": "770-392-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMC MEDICAL & DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-07",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "TEAM FINANCE LEADER",
        "authorized_official_telephone_number": "678-736-6342",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "026769",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "038861",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.