Summit Health Primary and Urgent Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SUMMIT HEALTH PRIMARY AND URGENT CARE LLC

Practice address

120 Handley Rd BLDG 400 Ste #410
Tyrone, GA 30290-3029

Phone

(678) 430-8478

NPI assigned

Jan 7, 2020

Last updated

Oct 2, 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

Jared Deraney, CRNA

Title

Owner

Phone

(480) 482-0934

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1730729849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935719",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935719",
            "telephone_number": "678-430-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HANDLEY RD BLDG 400 STE #410",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302903029",
            "telephone_number": "678-430-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT HEALTH PRIMARY AND URGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "DERANEY",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-482-0934",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.