Active NPI
Edward Kim
- Physical Therapist
- Atlanta, GA
National Provider Identifier
1699107524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT011107
- Practice address
- 57 Executive Park South NE Ste 190
Atlanta, GA 30329-2248 - Phone
- (404) 778-6390
- NPI assigned
- Aug 1, 2013
- Last updated
- Aug 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT011107 | GA | Primary |
Addresses
Primary practice location
57 Executive Park South NE Ste 190
Atlanta, GA 30329-2248
Mailing address
8259 Wicker Ave
Saint John, IN 46373-8878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT011107 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emory Physical Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- Atlanta, GA
- NPI 1922018423
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375315200000",
"number": "1699107524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8259 WICKER AVE",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57 EXECUTIVE PARK SOUTH NE STE 190",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292248",
"telephone_number": "404-778-6390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EDWARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-01",
"last_updated": "2013-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT011107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.