Privia Medical Group South Georgia, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIVIA MEDICAL GROUP SOUTH GEORGIA, LLC

Practice address

2402 Osler CT
Albany, GA 31707-0205

Phone

(229) 438-3300

NPI assigned

May 13, 2016

Last updated

May 13, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Graham Galka

Title

Vice President

Phone

(571) 295-7514

Specialties & licenses 2

Addresses

Practitioners 2

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.

• Kitty Bonita Sisk, PA-C

  • Physician Assistant
  • Albany, GA
  • NPI 1295885762

  Internal Medicine

  NPD
• Scarlett Ann Wade, FNP-C

  • Obstetrics & Gynecology Nurse Practitioner
  • Albany, GA
  • NPI 1013387331
  NPD

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

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1619323144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD",
            "address_2": "SUITE 4000",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031824",
            "telephone_number": "571-295-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 OSLER CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317070205",
            "telephone_number": "229-438-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP SOUTH GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-13",
        "last_updated": "2016-05-13",
        "status": "A",
        "authorized_official_last_name": "GALKA",
        "authorized_official_first_name": "GRAHAM",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "571-295-7514"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primus Day (Comp)
• Primus Day (Now)
• Primus Harding Street
• Primus Twinflower Road
• Bobby D Prince, M.D.
• Promiseland Home Care Agency LLC
• Prosperity and Purpose Counseling and Consulting, LLC
• Provision Dui Treatment
• Michael William Pruitt, D.O
• Pruitthealth - Palmyra, LLC (PruittHealth - Palmyra)

• Internal Medicine Physician in Albany, GA
• Providers in Albany, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; 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.