NPIMap

Organization Active NPI

My Doctors Clinic LLC

Doing business as Peach Clinic

  • Family Medicine Physician
  • Cumming, GA
National Provider Identifier
1497183941
Registry record updated Jan 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61431 Issued in GA
Legal business name
MY DOCTORS CLINIC LLC
Doing business as
Peach Clinic
Practice address
2320 Atlanta Hwy
Suite - 105
Cumming, GA 30040-6339
Phone
(678) 473-0715
NPI assigned
Oct 19, 2013
Last updated
Jan 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2014

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

Authorized official

Name
Ketan Ghia
Title
Manager
Phone
(678) 473-0715

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 052826 GA
Family Medicine Physician 207Q00000X 61431 GA Primary
Internal Medicine Physician 207R00000X 052826 GA
Pediatric Pulmonology Physician 2080P0214X 63536 GA
Sleep Medicine (Internal Medicine) Physician 207RS0012X 052826 GA

Addresses

Primary practice location

2320 Atlanta Hwy
Suite - 105
Cumming, GA 30040-6339

Mailing address

1754 Morningdale Cir
None
Duluth, GA 30097-5260
Phone (678) 473-0715

Other names 1

  • Peach Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140102000038 GA Part B Supplier - Clinic/Group Practice 2860620580 Receives reassigned benefits from 6 practitioners
Practice locations: Cumming, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2071528My Doctors Clinic, LLC2320 Atlanta Highway, Suite # 105, Cumming, GA 30040Certificate of waiverJan 13, 2028

National Provider Directory

National Provider Directory

Locations

3030 Old Atlanta Rd
Ste 500
Cumming, GA 30041
Phone (770) 203-1000

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1382140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389830400000",
    "number": "1497183941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1754 MORNINGDALE CIR",
            "address_2": "NONE",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975260",
            "telephone_number": "678-473-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 ATLANTA HWY",
            "address_2": "SUITE - 105",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300406339",
            "telephone_number": "678-473-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DOCTORS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-19",
        "last_updated": "2014-01-16",
        "status": "A",
        "authorized_official_last_name": "GHIA",
        "authorized_official_first_name": "KETAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "678-473-0715"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "052826",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "61431",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "052826",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "GA",
            "license": "63536",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "GA",
            "license": "052826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.