Premier South Medical Group, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

040754 Issued in GA

Legal business name

PREMIER SOUTH MEDICAL GROUP, P.C.

Practice address

3885 Princeton Lakes Way SW
Suite 412
Atlanta, GA 30331-5589

Phone

(404) 344-6000

Fax

(404) 344-6575

NPI assigned

Jan 26, 2007

Last updated

Dec 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ewaul Barrington Persaud Jr., M.D.

Title

President

Phone

(404) 344-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Premier South Medical Group2 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.

• Premier South Medical Group PC

  • Family Medicine Physician
  • Newnan, GA
  • NPI 1669916573
  NPD tax ID

Practitioners 5

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.

• Joel Terrance Isom, M.D.

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1194930222
  Medicare reassignment NPD
• Nakato B. Kibuyaga-Travis, M.D.

  • Family Medicine Physician
  • Douglasville, GA
  • NPI 1609031657
  Medicare reassignment NPD
• Audrey Caryn Roberson, NP-C

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1811495385
  Medicare reassignment NPD
• Natasha Williamson, NP

  • Primary Care Nurse Practitioner
  • Atlanta, GA
  • NPI 1386033132
  Medicare reassignment NPD
• Stanton Keith Collins, M.D.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1003178765
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1528114295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8750 NW 36TH ST",
            "address_2": "SUITE 300",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331782425",
            "telephone_number": "786-641-5348",
            "fax_number": "305-615-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW",
            "address_2": "SUITE 412",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315589",
            "telephone_number": "404-344-6000",
            "fax_number": "404-344-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SOUTH MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "PERSAUD",
        "authorized_official_first_name": "EWAUL",
        "authorized_official_middle_name": "BARRINGTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-344-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "040754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00318272A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Med Solutions LLC
• Premier Psychiatric & Psychotherapy Consulting
• Premier Psychiatric and Medical Consultants
• Premier Psychiatric and Psychotherapy Consulting, LLC
• Premier Shockwave, Inc.
• Premier Surgical Pavilion of Atlanta LLC
• Premier Testing and Screening Solutions, LLC
• Premier Vision Services
• Premiere Rehab Center L.L.C.
• Premiere Transitional Services, Inc.

• Family Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; 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.