Individual provider Active NPI

Kathy Petrie, ANP

  • Adult Health Nurse Practitioner
  • Stone Mountain, GA
National Provider Identifier
1598197667
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN314101 Issued in GA
Practice address
1825 Rockbridge Rd Ste 15B
Stone Mountain, GA 30087-3306
Phone
(470) 444-3134
Fax
(470) 276-4370
NPI assigned
Jul 31, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704271968 MI
Adult Health Nurse Practitioner 363LA2200X RN314101 GA Primary

Addresses

Primary practice location

1825 Rockbridge Rd Ste 15B
Stone Mountain, GA 30087-3306

Mailing address

PO Box 740013
Atlanta, GA 30374-0013
Phone (312) 733-9730

Other practice location 1

181 Emmett St W
Battle Creek, MI 49037-2963
Phone (269) 966-2600

Other practice location 2

7028 Highway 85
Riverdale, GA 30274-2946
Phone (470) 444-3136

Other practice location 3

1263 Moreland Ave SE
Atlanta, GA 30316-3183
Phone (470) 444-3137

Other practice location 4

3088 Washington Rd
East Point, GA 30344-4566
Phone (470) 444-3135

Other practice location 5

1631 Gordon Hwy Ste 17A
Augusta, GA 30906-2229
Phone (706) 230-7006

Other practice location 6

2732 Candler Rd
Decatur, GA 30034-1410
Phone (470) 444-3133

Other practice location 7

677 Cascade Ave SW
Atlanta, GA 30310-2404
Phone (470) 444-3143

Other practice location 8

625 S Marietta Pkwy SE
Marietta, GA 30060-2748
Phone (470) 377-7228

Other names 1

  • Kathy Feig Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926002400 GA Practitioner - Nurse Practitioner 5799919858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Street Health of Georgia PCGroup PAC ID 0345658647, 37 clinicians

Practice addresses (Care Compare)

1825 Rockbridge Rd
Suite 15B
Stone Mountain, GA 30087-3306
Phone (718) 765-6009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704271968MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health of Georgia PC Nurse Practitioner CurrentSince Sep 12, 2022 Accepting new patients
Qcpi-Villagemd, PC PastSince Sep 12, 2022 Accepting new patients
Johnson Regional Medical Center Past Accepting new patients

Locations

677 Cascade Ave SW
Atlanta, GA 30310
Phone (470) 444-3143

1263 Moreland Ave SE
Atlanta, GA 30316
Phone (470) 444-3137

1631 Gordon Hwy
Ste 17A
Augusta, GA 30906
Phone (706) 230-7006

2732 Candler Rd
Decatur, GA 30034
Phone (470) 444-3133

3088 Washington Rd
East Point, GA 30344
Phone (470) 444-3135

625 S Marietta Pkwy SE
Marietta, GA 30060
Phone (470) 377-7228

7028 Highway 85
Riverdale, GA 30274
Phone (470) 444-3136

1825 Rockbridge Rd
Ste 15B
Stone Mtn, GA 30087
Phone (470) 444-3134

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1a399bfe-f78b-4bd3-b22b-301d9fc9736a/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1598197667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740013",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740013",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 ROCKBRIDGE RD STE 15B",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873306",
            "telephone_number": "470-444-3134",
            "fax_number": "470-276-4370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "181 Emmett St W",
            "address_purpose": "LOCATION",
            "city": "Battle Creek",
            "state": "MI",
            "postal_code": "490372963",
            "country_code": "US",
            "telephone_number": "269-966-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7028 Highway 85",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302742946",
            "country_code": "US",
            "telephone_number": "470-444-3136",
            "fax_number": "470-298-7730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1263 Moreland Ave SE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303163183",
            "country_code": "US",
            "telephone_number": "470-444-3137",
            "fax_number": "470-202-3003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3088 Washington Rd",
            "address_purpose": "LOCATION",
            "city": "East Point",
            "state": "GA",
            "postal_code": "303444566",
            "country_code": "US",
            "telephone_number": "470-444-3135",
            "fax_number": "404-777-9336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1631 Gordon Hwy Ste 17A",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309062229",
            "country_code": "US",
            "telephone_number": "706-230-7006",
            "fax_number": "762-257-7442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2732 Candler Rd",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300341410",
            "country_code": "US",
            "telephone_number": "470-444-3133",
            "fax_number": "470-276-4051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "677 Cascade Ave SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303102404",
            "country_code": "US",
            "telephone_number": "470-444-3143",
            "fax_number": "470-467-7469",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "625 S Marietta Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300602748",
            "country_code": "US",
            "telephone_number": "470-377-7228",
            "fax_number": "470-467-7583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "KATHY",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704271968",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN314101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "FEIG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Stone Mountain, GA

Sources for this page

Verify at the official NPI Registry.