NPIMap

Individual provider Active NPI

Charlotte Elizabeth Grayson- Mathis, M.D.

  • Internal Medicine Physician
  • Fayetteville, GA
National Provider Identifier
1497779391
Registry record updated Feb 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
LL057811 Issued in GA
Practice address
101 Yorktown Drive
Fayetteville, GA 30214
Phone
(770) 801-2526
NPI assigned
Jul 26, 2006
Last updated
Feb 17, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LL057811 GA Primary

Addresses

Primary practice location

101 Yorktown Drive
Fayetteville, GA 30214

Mailing address

4742 Longcourt Dr SE
Smyrna, GA 30080-7194
Phone (678) 427-0734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061116000018 GA Practitioner - Internal Medicine 2668470212 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Boston University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

101 Yorktown Dr
Fayetteville, GA 30214-1578

101 Yorktown Dr
Suite 100
Fayetteville, GA 30214-7663
Phone (770) 460-4285

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
LL057811GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Mar 2, 2015 Accepting new patients
Compassus Op of Georgia II LLC CurrentSince Apr 20, 2023 Accepting new patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Mar 2, 2015 Accepting new patients
Privia Pediatric Medical Group of Georgia LLC Current Accepting new patients
Hospice Advantage, LLC CurrentSince Feb 15, 2022 Accepting new patients
Hospice Advantage, LLC CurrentSince Feb 15, 2022 Accepting new patients
Hospice Advantage, LLC Past Accepting new patients
Piedmont Providers LLC Internal Medicine Past Accepting new patients

Locations

3235 Satellite Blvd
Ste 290
Duluth, GA 30096
Phone (770) 449-8142

101 Yorktown Dr
Fayetteville, GA 30214
Phone (770) 460-4281

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

300 Chastain Center Blvd NW
Ste 345
Kennesaw, GA 30144
Phone (770) 218-1997

1100 Northside Xing
Macon, GA 31210
Phone (478) 321-9071

450 Mall Blvd
Ste A
Savannah, GA 31406
Phone (912) 354-3727

10 Cadillac Dr
Ste 400
Brentwood, TN 37027
Phone (615) 637-9163

Interoperability endpoints

  • Direct secure messaging: charlotte.grayson-mathis.1@8042.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Compassus-FayettevilleFayetteville, GA, CCN 111649 Hospice Contracted Managing Employee Oct 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297900800000",
    "number": "1497779391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4742 LONGCOURT DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300807194",
            "telephone_number": "678-427-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 YORKTOWN DRIVE",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "770-801-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYSON- MATHIS",
        "first_name": "CHARLOTTE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2011-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "LL057811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.