NPIMap

Organization Active NPI

Atlanta South Endoscopy Center LLC

Doing business as Riverdale Endoscopy Center

  • Endoscopy Clinic/Center
  • Riverdale, GA
National Provider Identifier
1669533568
Registry record updated May 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
Legal business name
ATLANTA SOUTH ENDOSCOPY CENTER LLC
Doing business as
Riverdale Endoscopy Center
Practice address
34 Upper Riverdale Rd SE
Suite 201
Riverdale, GA 30274-2635
Phone
(678) 904-9710
Fax
(678) 904-9712
NPI assigned
Dec 13, 2006
Last updated
May 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2017

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

Authorized official

Name
Jana Baker
Title
Administrator
Phone
(404) 888-7575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X Primary

Addresses

Primary practice location

34 Upper Riverdale Rd SE
Suite 201
Riverdale, GA 30274-2635

Mailing address

34 Upper Riverdale Rd SE
Suite 201
Riverdale, GA 30274-2635
Phone (678) 904-9710

Other names 1

  • Riverdale Endoscopy Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669533568. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001267

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ATLANTA SOUTH ENDOSCOPY CENTER, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Oct 31, 2005
Last certification
Aug 10, 2017
Ownership / control type
Proprietary
Facility address
34 Upper Riverdale Road, Suite 201-B
Riverdale, GA 30274

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1669533568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 UPPER RIVERDALE RD SE",
            "address_2": "SUITE 201",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742635",
            "telephone_number": "678-904-9710",
            "fax_number": "678-904-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 UPPER RIVERDALE RD SE",
            "address_2": "SUITE 201",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742635",
            "telephone_number": "678-904-9710",
            "fax_number": "678-904-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA SOUTH ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-888-7575"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverdale Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, GA

Sources for this page

Verify at the official NPI Registry.