NPIMap

Organization Active NPI

Pandya Medical Center, Inc

  • Family Medicine Physician
  • Johns Creek, GA
National Provider Identifier
1730501586
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60956 Issued in GA
Legal business name
PANDYA MEDICAL CENTER, INC
Practice address
11315 Johns Creek Pkwy
Johns Creek, GA 30097-2645
Phone
(770) 709-6922
Fax
(770) 709-6910
NPI assigned
Jan 14, 2014
Last updated
Sep 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Tanya O. Pandya, D.O.NPI 1639354434
Title
President
Phone
(678) 984-3151

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 60956 GA Primary

Addresses

Primary practice location

11315 Johns Creek Pkwy
Johns Creek, GA 30097-2645

Mailing address

11555 Medlock Bridge Rd Ste 190
Johns Creek, GA 30097-1541
Phone (678) 984-3151

Other identifiers 1

IdentifierTypeStateIssuer
60956OtherGAGA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140314000813 GA Part B Supplier - Clinic/Group Practice 8022249028 Receives reassigned benefits from 26 practitioners
Practice locations: Dawsonville, GA; Lawrenceville, GA; Johns Creek, GA; Cumming, GA; Braselton, GA; Alpharetta, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2074428Pandya Medical Center11315 Johns Creek Parkway, Johns Creek, GA 30097Certificate of waiverMar 9, 2028

National Provider Directory

National Provider Directory

Locations

11975 Morris Rd
Ste 210
Alpharetta, GA 30005
Phone (770) 664-0088

5670 Old Winder Hwy
Ste 101
Braselton, GA 30517
Phone (770) 709-6922

3970 Dep Bill Cantrell Memorial Rd
Ste 203
Cumming, GA 30040
Phone (770) 887-5159

3970 Dep Bill Cantrell Memorial Rd
Ste 220
Cumming, GA 30040
Phone (678) 984-3151

11555 Medlock Bridge Rd
Ste 190
Johns Creek, GA 30097

601 Professional Dr
Ste 220
Lawrenceville, GA 30046
Phone (770) 339-4526

3825 Johns CRK Pkwy Ste a
Suwanee, GA 30024

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8348/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1730501586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 MEDLOCK BRIDGE RD STE 190",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971541",
            "telephone_number": "678-984-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11315 JOHNS CREEK PKWY",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300972645",
            "telephone_number": "770-709-6922",
            "fax_number": "770-709-6910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANDYA MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "PANDYA",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-984-3151",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "60956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA MEDICAL LICENSE",
            "identifier": "60956",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.