NPIMap

Organization Active NPI

Reproductive Health Medicine & Gynecology

  • Reproductive Endocrinology Physician
  • Norcross, GA
National Provider Identifier
1538645908
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
Legal business name
REPRODUCTIVE HEALTH MEDICINE & GYNECOLOGY
Practice address
3965 Holcomb Bridge Rd Ste 100
Norcross, GA 30092-2203
Phone
(470) 535-9379
NPI assigned
Jul 18, 2018
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Nicholas KongoasaNPI 1376895946
Title
Cmo
Phone
(770) 450-8677

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
Reproductive Endocrinology Physician 207VE0102X NU Primary

Addresses

Primary practice location

3965 Holcomb Bridge Rd Ste 100
Norcross, GA 30092-2203

Mailing address

3965 Holcomb Bridge Rd Ste 100
Norcross, GA 30092-2203

Other practice location 1

1326 Main St Ste 116
Gardendale, AL 35071-2509
Phone (770) 450-8677

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2249837Reproductive Health Medicine & Gynecology Alabama1326 Main Street, Ste 116, Gardendale, AL 35071Certificate of waiverJan 23, 2028
11D2276665Reproductive HLTH Medicine & Gynecology - Georgia3965 Holcomb Bridge Road, Suite 100, Peachtree Corners, GA 30092Certificate of waiverFeb 13, 2027

National Provider Directory

National Provider Directory

Locations

1326 Main St
Ste 116
Gardendale, AL 35071
Phone (770) 450-8677

Practitioners & affiliated clinicians

Practitioners 11

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": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1538645908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 HOLCOMB BRIDGE RD STE 100",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 HOLCOMB BRIDGE RD STE 100",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922203",
            "telephone_number": "470-535-9379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1326 Main St Ste 116",
            "address_purpose": "LOCATION",
            "city": "Gardendale",
            "state": "AL",
            "postal_code": "350712509",
            "country_code": "US",
            "telephone_number": "770-450-8677",
            "fax_number": "678-792-8927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REPRODUCTIVE HEALTH MEDICINE & GYNECOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2023-09-06",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "KONGOASA",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "770-450-8677"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.