Phoenix Clinic and Afterhour Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

060359 Issued in GA

Legal business name

PHOENIX CLINIC AND AFTERHOUR CARE

Practice address

2795 Main St W # 21
Snellville, GA 30078-3164

Phone

(678) 386-2929

NPI assigned

Aug 22, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Marie Lightbourne, MDNPI 1114104767

Title

Owner

Phone

(678) 386-2929

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marie Lightbourne, MD

  • Family Medicine Physician
  • Snellville, GA
  • NPI 1114104767
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1720569403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5858 SILVER RIDGE DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300872322",
            "telephone_number": "678-386-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2795 MAIN ST W # 21",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783164",
            "telephone_number": "678-386-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CLINIC AND AFTERHOUR CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "LIGHTBOURNE",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-386-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "060359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Kathleen Peterson, DC
• John Alton Pettay, FNP C
• Uyen Minh Pham
• David F Phelps, D.C.
• Taylor Phillips, RBT
• Physical Rehab Medicine Specialists LLC
• Dale Piacentine
• Sarat Mallik Piduru, M.D.
• Piedmont Eastside Rheumatology, LLC
• Daphne L Pierce-Smith, RN

• Family Medicine Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; 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.