NPIMap

Organization Active NPI

Leeway Medical Group, P.C.

  • Internal Medicine Physician
  • Douglasville, GA
National Provider Identifier
1598857229
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LEEWAY MEDICAL GROUP, P.C.
Practice address
8311 Office Park Dr
Douglasville, GA 30134-6935
Phone
(770) 577-6121
Fax
(770) 577-1152
NPI assigned
Sep 29, 2006
Last updated
Nov 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Marvin Lee III MD, M.D.
Title
President
Phone
(770) 577-6121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

8311 Office Park Dr
Douglasville, GA 30134-6935

Mailing address

1665 Waterway Xing SW
Atlanta, GA 30331-8060
Phone (770) 577-6121

Other identifiers 3

IdentifierTypeStateIssuer
CH8739OtherGAMCRR
52255410 001OtherGABCBS
0400158OtherGAEVERCARE

National Provider Directory

National Provider Directory
Tax ID family
Leeway Medical Group PC2 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.

Locations

8311 Office Park Dr
Douglasville, GA 30134
Phone (770) 577-6121

Practitioners & affiliated clinicians

Practitioners 8

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1598857229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 WATERWAY XING SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318060",
            "telephone_number": "770-577-6121",
            "fax_number": "770-577-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8311 OFFICE PARK DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301346935",
            "telephone_number": "770-577-6121",
            "fax_number": "770-577-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEEWAY MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "LEE III MD",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-577-6121",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCRR",
            "identifier": "CH8739",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52255410 001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0400158",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.