NPIMap

Organization Active NPI

Grupo Medico de Georgia, LLC

  • Family Medicine Physician
  • Norcross, GA
National Provider Identifier
1639574890
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38981 Issued in GA
Legal business name
GRUPO MEDICO DE GEORGIA, LLC
Practice address
5955 Jimmy Carter Blvd
Suite 100
Norcross, GA 30071-4641
Phone
(770) 559-3555
NPI assigned
Oct 30, 2014
Last updated
Dec 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Authorized official

Name
Eddy Lajara
Title
General Manager
Phone
(770) 831-9202

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CHIR008572 GA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 38981 GA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X RN105078 GA

Addresses

Primary practice location

5955 Jimmy Carter Blvd
Suite 100
Norcross, GA 30071-4641

Mailing address

4225 S Lee St Ste B
Buford, GA 30518-3658
Phone (770) 831-9202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210507001431 GA Part B Supplier - Clinic/Group Practice 2062821887 Receives reassigned benefits from 5 practitioners
Practice locations: Norcross, GA

National Provider Directory

National Provider Directory
Tax ID family
Grupo Medico de Georgia LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1060 Veterans Memorial Hwy SW
Ste 200
Mableton, GA 30126
Phone (770) 672-6903

5955 Jimmy Carter Blvd
Ste 100
Norcross, GA 30071
Phone (770) 559-3555

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1639574890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 S LEE ST STE B",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183658",
            "telephone_number": "770-831-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 JIMMY CARTER BLVD",
            "address_2": "SUITE 100",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300714641",
            "telephone_number": "770-559-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRUPO MEDICO DE GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "LAJARA",
        "authorized_official_first_name": "EDDY",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "770-831-9202"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008572",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "38981",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN105078",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; 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.

Verify at the official NPI Registry.