NPIMap

Organization Active NPI

Georgia Surgicare

  • Multi-Specialty Clinic/Center
  • Loganville, GA
National Provider Identifier
1508150509
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GEORGIA SURGICARE
Practice address
367 Athens Hwy
Building 100 Suite 100a
Loganville, GA 30052-2204
Phone
(678) 466-6760
Fax
(678) 802-7094
NPI assigned
Jun 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Christopher Ibikunle, MDNPI 1992981302
Title
Ceo
Phone
(678) 466-6760

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

367 Athens Hwy
Building 100 Suite 100a
Loganville, GA 30052-2204

Mailing address

367 Athens Hwy
Building 100 Suite 100a
Loganville, GA 30052-2204
Phone (678) 466-6760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110801000276 GA Part B Supplier - Clinic/Group Practice 8325217714 Receives reassigned benefits from 9 practitioners
Practice locations: Loganville, GA

National Provider Directory

National Provider Directory
Tax ID family
Georgia Surgicare9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

367 Athens Hwy
Ste 1800
Loganville, GA 30052
Phone (770) 289-0065

367 Athens Hwy
#78
Loganville, GA 30052

367 Athens Hwy
Ste 100B
Loganville, GA 30052

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1508150509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY",
            "address_2": "BUILDING 100 SUITE 100A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522204",
            "telephone_number": "678-466-6760",
            "fax_number": "678-802-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY",
            "address_2": "BUILDING 100 SUITE 100A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522204",
            "telephone_number": "678-466-6760",
            "fax_number": "678-802-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA SURGICARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "IBIKUNLE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-466-6760",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.