NPIMap

Organization Active NPI

CPC-Gateway

  • Family Medicine Physician
  • Grovetown, GA
National Provider Identifier
1689014763
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CPC-GATEWAY
Practice address
4039 Gateway Blvd
Grovetown, GA 30813-3195
Phone
(706) 922-1600
Fax
(706) 922-1010
NPI assigned
Jul 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Michael Friedman
Title
MD
Phone
(706) 922-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4039 Gateway Blvd
Grovetown, GA 30813-3195

Mailing address

PO Box 1967
Evans, GA 30809-1967

National Provider Directory

National Provider Directory
Tax ID family
Center for Primary Care PC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

4039 Gateway Blvd
Grovetown, GA 30813
Phone (706) 498-9570

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1689014763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1967",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308091967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4039 GATEWAY BLVD",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133195",
            "telephone_number": "706-922-1600",
            "fax_number": "706-922-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPC-GATEWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-03",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "706-922-1600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grovetown, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.