Internal Medicine Associates of Lawrenceville PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

038744 Issued in GA

Legal business name

INTERNAL MEDICINE ASSOCIATES OF LAWRENCEVILLE PC

Practice address

748 Old Norcross Rd
Suite 150
Lawrenceville, GA 30046-3393

Phone

(770) 338-5070

Fax

(770) 338-2568

NPI assigned

Jul 23, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Agbor N Egbewatt, M.D

Title

President

Phone

(770) 338-5070

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1467617043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 OLD NORCROSS RD",
            "address_2": "SUITE 150",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463393",
            "telephone_number": "770-338-5070",
            "fax_number": "770-338-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 OLD NORCROSS RD",
            "address_2": "SUITE 150",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463393",
            "telephone_number": "770-338-5070",
            "fax_number": "770-338-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF LAWRENCEVILLE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-23",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "EGBEWATT",
        "authorized_official_first_name": "AGBOR",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-338-5070",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "038744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000631463C",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; 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.