NPIMap

Organization Active NPI

Personalized Primary Care of Atlanta LLC

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1740506427
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
043699 Issued in GA
Legal business name
PERSONALIZED PRIMARY CARE OF ATLANTA LLC
Practice address
57 Executive Park S
Ste 390
Atlanta, GA 30329-2288
Phone
(404) 371-1033
Fax
(404) 997-6790
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Authorized official

Name
Dr. Juliet K. Mavromatis, MDNPI 1528168747
Title
President/Owner
Phone
(404) 583-0978

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 043699 GA Primary

Addresses

Primary practice location

57 Executive Park S
Ste 390
Atlanta, GA 30329-2288

Mailing address

57 Executive Park S Ste 390
Atlanta, GA 30329-2255
Phone (404) 997-6790

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100806000095 GA Part B Supplier - Clinic/Group Practice 4789717018 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

57 Executive Park South NE
Ste 390
Atlanta, GA 30329
Phone (404) 371-1033

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1bd57171-f0fc-42ae-9baf-e255a76f2819/

Practitioners & affiliated clinicians

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": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1740506427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 EXECUTIVE PARK S STE 390",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292255",
            "telephone_number": "404-997-6790",
            "fax_number": "404-997-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 EXECUTIVE PARK S",
            "address_2": "STE 390",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292288",
            "telephone_number": "404-371-1033",
            "fax_number": "404-997-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED PRIMARY CARE OF ATLANTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "MAVROMATIS",
        "authorized_official_first_name": "JULIET",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "404-583-0978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "043699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.