Active NPI
Emory Physicians Group, LLC
- Clinic/Center
- Atlanta, GA
National Provider Identifier
1548680796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- EMORY PHYSICIANS GROUP, LLC
- Practice address
- 22 14TH Street NW
Space 129
Atlanta, GA 30309 - Phone
- (404) 504-6554
- Fax
- (404) 999-7964
- NPI assigned
- Apr 25, 2014
- Organization subpart
- Yes
- Parent organization
- THE EMORY CLINIC, INC
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 Crawford Long Hospital
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
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
1841 Clifton Rd NE
Rm 504
Atlanta, GA 30329
650 North Ave NE
#S204
Atlanta, GA 30308
Phone (404) 504-6554
1311 Johnson Ferry Rd
Ste 604
Marietta, GA 30068
Practitioners & affiliated clinicians
Practitioners 19
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": "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.