South Atlanta Primary Care PC

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

022223 Issued in GA

Legal business name

SOUTH ATLANTA PRIMARY CARE PC

Practice address

6568A Tara Blvd
Jonesboro, GA 30236-1228

Phone

(770) 968-7933

Fax

(770) 968-6521

NPI assigned

Jun 21, 2007

Last updated

Aug 22, 2020By 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

Dr. Michael Angel Dicristina, MDNPI 1144226135

Title

Physician Owner

Phone

(770) 968-7933

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26481/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Michael Angel Dicristina, M.D.

  • Internal Medicine Physician
  • Riverdale, GA
  • NPI 1144226135
  Authorized official Same address or phone
• Kameelah L. Ellis, NP

  • Nurse Practitioner
  • Riverdale, GA
  • NPI 1306360060
  NPD (past)

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710183454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6568A TARA BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361228",
            "telephone_number": "770-968-7933",
            "fax_number": "770-968-6521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6568A TARA BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361228",
            "telephone_number": "770-968-7933",
            "fax_number": "770-968-6521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTA PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICRISTINA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANGEL",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "770-968-7933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "022223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND NPI NUMBER",
            "identifier": "1144226135",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Legal Medicine in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Legal Medicine in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.