St. Jude's Internal Medicine, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ST. JUDE'S INTERNAL MEDICINE, LLC

Practice address

1198 Buckhead Xing
Ste C
Woodstock, GA 30189-4257

Phone

(678) 324-7406

Fax

(770) 627-4322

NPI assigned

Oct 7, 2010

Organization subpart

No

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

Authorized official

Name

Osborne F D'Souza, MDNPI 1437148657

Title

Provider

Phone

(678) 324-7406

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Osborne D'Souza, MD

  • Internal Medicine Physician
  • Woodstock, GA
  • NPI 1437148657
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399507200000",
    "number": "1477863579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1198 BUCKHEAD XING",
            "address_2": "STE C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301894257",
            "telephone_number": "678-324-7406",
            "fax_number": "770-627-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1198 BUCKHEAD XING",
            "address_2": "STE C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301894257",
            "telephone_number": "678-324-7406",
            "fax_number": "770-627-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE'S INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2014-05-08",
        "status": "A",
        "authorized_official_last_name": "D'SOUZA",
        "authorized_official_first_name": "OSBORNE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "678-324-7406",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Springer
• Jennifer N Spruce, PT
• SRR LLC (Simple Smiles Restorative And Cosmetic Dentistry)
• Ashley St Jules
• Andrew J St. Bernard, D.C.
• Anna Marie Sta. Maria-Nase, SLP
• Abigail Stacy
• Kathryn Theresa Stanchev, CSA, CST
• Immari Stanley, LMT
• Glenda Partrece Stansell, D.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.