NPIMap

Organization Active NPI

Amarc Medical & Research Clinic

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1497951081
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
AMARC MEDICAL & RESEARCH CLINIC
Practice address
1309 Lakewood Ave SE
Atlanta, GA 30315-2312
Phone
(404) 838-0904
Fax
(770) 446-2686
NPI assigned
Jun 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Bona Ilonzo
Title
Administrator
Phone
(404) 838-0904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1309 Lakewood Ave SE
Atlanta, GA 30315-2312

Mailing address

PO Box 767
Fairburn, GA 30213-0767
Phone (404) 838-0904

National Provider Directory

National Provider Directory
Tax ID family
Amarc Medical Research Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1309 Lakewood Ave SE
Atlanta, GA 30315
Phone (404) 838-0904

Practitioners & affiliated clinicians

Practitioners 2

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": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497951081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302130767",
            "telephone_number": "404-838-0904",
            "fax_number": "770-446-2686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 LAKEWOOD AVE SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303152312",
            "telephone_number": "404-838-0904",
            "fax_number": "770-446-2686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMARC MEDICAL & RESEARCH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILONZO",
        "authorized_official_first_name": "BONA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-838-0904"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.