NPIMap

Organization Active NPI

Georgia Sports Medicine, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Duluth, GA
National Provider Identifier
1710160601
Registry record updated Oct 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
043191 Issued in GA
Legal business name
GEORGIA SPORTS MEDICINE, LLC
Practice address
6340 Sugarloaf Pkwy
Ste 375
Duluth, GA 30097-4333
Phone
(770) 814-2223
Fax
(770) 814-2232
NPI assigned
Dec 13, 2007
Last updated
Oct 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2011

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

Authorized official

Name
Dr. Mark Cullen, MDNPI 1497722219
Title
Propietor
Phone
(770) 814-2223

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 043191 GA Primary

Addresses

Primary practice location

6340 Sugarloaf Pkwy
Ste 375
Duluth, GA 30097-4333

Mailing address

6340 Sugarloaf Pkwy
Ste 375
Duluth, GA 30097-4333
Phone (770) 814-2223

Other identifiers 1

IdentifierTypeStateIssuer
GRP5069OtherGAMEDICARE GROUP ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1710160601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6340 SUGARLOAF PKWY",
            "address_2": "STE 375",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974333",
            "telephone_number": "770-814-2223",
            "fax_number": "770-814-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6340 SUGARLOAF PKWY",
            "address_2": "STE 375",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974333",
            "telephone_number": "770-814-2223",
            "fax_number": "770-814-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "CULLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PROPIETOR",
        "authorized_official_telephone_number": "770-814-2223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "043191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "GRP5069",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; 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.