NPIMap

Organization Active NPI

Supreme Healthcare OB/GYN LLC

  • Specialist
  • Decatur, GA
National Provider Identifier
1639552649
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
57621 Issued in GA
Legal business name
SUPREME HEALTHCARE OB/GYN LLC
Practice address
5536 Flat Shoals Pkwy
Suite a
Decatur, GA 30034-5408
Phone
(678) 518-9691
Fax
(678) 518-9692
NPI assigned
Jul 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Authorized official

Name
Ms. Kimar Dunn
Title
Assistant Practice Manager
Phone
(678) 518-9691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 57621 GA Primary

Addresses

Primary practice location

5536 Flat Shoals Pkwy
Suite a
Decatur, GA 30034-5408

Mailing address

5536 Flat Shoals Pkwy
Suite a
Decatur, GA 30034-5408
Phone (678) 518-9691

National Provider Directory

National Provider Directory

Locations

5536 Flat Shoals Pkwy
#A
Decatur, GA 30034
Phone (678) 518-9691

Practitioners & affiliated clinicians

Practitioners 1

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": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1639552649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5536 FLAT SHOALS PKWY",
            "address_2": "SUITE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345408",
            "telephone_number": "678-518-9691",
            "fax_number": "678-518-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5536 FLAT SHOALS PKWY",
            "address_2": "SUITE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345408",
            "telephone_number": "678-518-9691",
            "fax_number": "678-518-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HEALTHCARE OB/GYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "KIMAR",
        "authorized_official_title_or_position": "ASSISTANT PRACTICE MANAGER",
        "authorized_official_telephone_number": "678-518-9691",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "57621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; 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.