Georgia Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

52073 Issued in GA

Legal business name

GEORGIA MEDICAL CENTER

Practice address

3945 Lawrenceville Hwy NW
Lilburn, GA 30047-2817

Phone

(678) 380-8353

NPI assigned

Oct 10, 2007

Organization subpart

No

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

Authorized official

Name

Syed A Ali

Title

Practice Manager

Phone

(770) 910-2377

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1497943948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3945 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472817",
            "telephone_number": "678-380-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3945 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472817",
            "telephone_number": "678-380-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "SYED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-910-2377"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "52073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189134074B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lilburn, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.