Beltline Bariatric and Surgical Group LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

BELTLINE BARIATRIC AND SURGICAL GROUP LLC

Practice address

371 E Paces Ferry Rd NE Ste 750
Atlanta, GA 30305-2372

Phone

(470) 419-4380

Fax

(470) 298-7736

NPI assigned

May 9, 2016

Last updated

Nov 1, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Diana Kapou Wong

Title

Coo

Phone

(770) 686-1366

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: cproctermd@beltline.azalea.phimailbox.com

Practitioners 11

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.

• Vishwanath Raju Danthuluri, MD

  • Surgery Physician
  • Atlanta, GA
  • NPI 1699118844
  Medicare reassignment Care Compare group NPD
• Roger Francis Eduardo, M.D.

  • Surgery Physician
  • Newnan, GA
  • NPI 1962792366
  Medicare reassignment Care Compare group NPD
• Charles Daniel Procter Jr., MD

  • Surgery Physician
  • Atlanta, GA
  • NPI 1598780488
  Medicare reassignment Care Compare group NPD
• Jennifer M Robinson, NP-C

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1790072601
  Medicare reassignment NPD
• Mary Elizabeth Florio, NP

  • Family Nurse Practitioner
  • Newnan, GA
  • NPI 1720763394
  NPD
• Charity Ross Morgan, AGPCNP-BC

  • Nurse Practitioner
  • Newnan, GA
  • NPI 1215584800
  NPD
• Jeanette Shelley, RD, LD

  • Registered Dietitian
  • Newnan, GA
  • NPI 1134717168
  NPD
• Kathryn Brianne Fuss, MMS, PA-C

  • Physician Assistant
  • Atlanta, GA
  • NPI 1609213529
  NPD (past)
• William Jeffrey McDaniel, MD

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1437243334
  NPD (past)
• Stacy Ann Paine, RD, LD

  • Registered Dietitian
  • Atlanta, GA
  • NPI 1154576445
  NPD (past)
• Tiffany Payne, FNP-C

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1730645219
  NPD (past)

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1700232865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 E PACES FERRY RD NE STE 750",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303052372",
            "telephone_number": "470-419-4380",
            "fax_number": "470-298-7736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E PACES FERRY RD NE STE 750",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303052372",
            "telephone_number": "470-419-4380",
            "fax_number": "470-298-7736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Bullsboro Dr Ste B-C",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302631680",
            "country_code": "US",
            "telephone_number": "770-683-3230",
            "fax_number": "470-298-7732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 Eagles Landing Pkwy Ste 204",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302819082",
            "country_code": "US",
            "telephone_number": "678-782-3866",
            "fax_number": "470-298-7732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BELTLINE BARIATRIC AND SURGICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2023-11-01",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "KAPOU",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-686-1366",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cproctermd@beltline.azalea.phimailbox.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "371 E Paces Ferry Rd NE Ste 740",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303052372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angeline Belnavis
• Deliane Beloni-Bussey, AU.D.
• Nicole Michelle Belotserkovskiy
• Oksana Belova, BCBA
• Martin G Belson, MD
• Beltline Weight Loss LLC (Beltline Weight Loss and Obesity Medicine LLC)
• Ashley Nicole Belton, RN
• Mario Raul Beltran, DPT
• Melissa Beltran
• Maday Beltrons Diaz

• Surgery Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.