NPIMap

Organization Active NPI

Emory Physicians Group, LLC

Doing business as The Emory Clinic, Inc.

  • Clinic/Center
  • Atlanta, GA
National Provider Identifier
1548680796
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EMORY PHYSICIANS GROUP, LLC
Doing business as
The Emory Clinic, Inc.
Practice address
22 14TH Street NW
Space 129
Atlanta, GA 30309
Phone
(404) 504-6554
Fax
(404) 999-7964
NPI assigned
Apr 25, 2014
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
THE EMORY CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Stephanie Vicent
Title
Director
Phone
(404) 778-5352

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

22 14TH Street NW
Space 129
Atlanta, GA 30309

Mailing address

PO Box 102404
Pasadena, CA 91189-2404

Other names 1

  • The Emory Clinic, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408001960 GA Part B Supplier - Clinic/Group Practice 6709294804 Receives reassigned benefits from 18 practitioners
Practice locations: Marietta, GA; Dunwoody, GA; Atlanta, GA

National Provider Directory

National Provider Directory
Part of
Emory Clinic ASC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • The Emory Clinic Inc

    dba Emory Ambulatory Surgery Center at Spivey Station

    • Ambulatory Surgical Clinic/Center
    • Jonesboro, GA
    • NPI 1386165504

    Member Of

    NPD member

Locations

1841 Clifton Rd NE
Rm 504
Atlanta, GA 30329

3280 Peachtree Rd NE
Ste 115
Atlanta, GA 30305
Phone (404) 504-6554

500 Ashwood Pkwy
Bldg E
Atlanta, GA 30338
Phone (404) 504-6554

650 North Ave NE
#S204
Atlanta, GA 30308
Phone (404) 504-6554

950 Battery Ave SE
Ste 1216
Atlanta, GA 30339
Phone (404) 504-6554

1311 Johnson Ferry Rd
Marietta, GA 30068
Phone (770) 977-4139

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1548680796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102404",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911892404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 14TH STREET NW",
            "address_2": "SPACE 129",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30309",
            "telephone_number": "404-504-6554",
            "fax_number": "404-999-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMORY PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE EMORY CLINIC, INC",
        "enumeration_date": "2014-04-25",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "VICENT",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-778-5352"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Emory Clinic, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Emory Clinic, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 27, 2020; 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.