San Pablo Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SAN PABLO CLINIC, LLC

Practice address

1301 Broadrick Dr
Dalton, GA 30720-3008

Phone

(706) 270-5990

Fax

(706) 270-5992

NPI assigned

Oct 17, 2014

Organization subpart

No

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

Authorized official

Name

Julia Garcia, MDNPI 1174512321

Title

Member/Manager

Phone

(706) 313-9059

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julia Garcia, M.D.

  • Internal Medicine Physician
  • Dalton, GA
  • NPI 1174512321
  Medicare reassignment NPD Authorized official
• Lisa Irene Griggs, M.D.

  • Family Medicine Physician
  • Dalton, GA
  • NPI 1073563250
  NPD (past)
• Carmelita Mabanta, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Neptune, NJ
  • NPI 1801879598
  NPD (past)

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1689078842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 KEYSTONE WAY",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307204812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 BROADRICK DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203008",
            "telephone_number": "706-270-5990",
            "fax_number": "706-270-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PABLO CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "706-313-9059",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edgardo J Salas-Robles, DC
• Anna Salazar, PA-C
• Clarena Salcedo, NP-C
• Mei Laarnee Salmorin, OT
• Laura Lynn Sams, MED, CCC-SLP
• Astrid Karolina Sanchez, MD
• Wilfredo Sanchez
• Drayton M Sanders, MD
• Jessica Sanders, FNP
• Muhammad Aslam Sandvi, MD

• Primary Care Clinic/Center in Dalton, GA
• Providers in Dalton, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.