Active NPI
Family Practice of Conyers Inc
- Family Medicine Physician
- Conyers, GA
National Provider Identifier
1720146301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FAMILY PRACTICE OF CONYERS INC
- Practice address
- 1039 E Freeway Dr SE
Conyers, GA 30094-5965 - Phone
- (770) 922-0076
- Fax
- (770) 922-0734
- NPI assigned
- Dec 5, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Alvin Vincent Griffin, MD
- Title
- Medical Director
- Phone
- (770) 922-0076
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1039 E Freeway Dr SE
Conyers, GA 30094-5965
Mailing address
1039 E Freeway Dr SE
Conyers, GA 30094-5965
Phone (770) 922-0076
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00412849I | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040429000552 | GA | Part B Supplier - Clinic/Group Practice | 0244227387 |
Receives reassigned benefits from 2 practitioners Practice locations: Conyers, GA |
National Provider Directory
National Provider DirectoryLocations
1039 E Freeway Dr SE
Conyers, GA 30094
Phone (770) 922-0076
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687219200000",
"number": "1720146301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1039 E FREEWAY DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300945965",
"telephone_number": "770-922-0076",
"fax_number": "770-922-0734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1039 E FREEWAY DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300945965",
"telephone_number": "770-922-0076",
"fax_number": "770-922-0734"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY PRACTICE OF CONYERS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-05",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A",
"authorized_official_last_name": "GRIFFIN",
"authorized_official_first_name": "ALVIN",
"authorized_official_middle_name": "VINCENT",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "770-922-0076",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00412849I",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.