Irene Ristic, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

037660 Issued in GA

Practice address

902 Athens Hwy
Loganville, GA 30052-4904

Phone

(770) 554-5533

Fax

(770) 554-8129

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Irena Ristic Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1649316464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MAYFIELD FARMS DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436161",
            "telephone_number": "770-271-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 ATHENS HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524904",
            "telephone_number": "770-554-5533",
            "fax_number": "770-554-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISTIC",
        "first_name": "IRENE",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "037660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00572448B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENA",
            "last_name": "RISTIC",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth Reisig
• Renach Care Services, LLC
• Resilient Keys Counseling LLC
• Revive Orthopedics Spine & Sports Medicine, Inc (Revive Orthopedics Spine & Sports Medicine)
• Joseph Riescher
• Deborah M Roberts, PHARMD
• Don Lewis Roberts, PHARM.D.
• Gretchen Roberts, M OT
• Jennifer Roberts, PHD
• Lori G Roberts, CPNP

• Family Medicine Physician in Loganville, GA
• Providers in Loganville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.