Atlanta Personalized Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ATLANTA PERSONALIZED MEDICINE LLC

Practice address

5667 Peachtree Dunwoody Rd Ste 200
Atlanta, GA 30342-1725

Phone

(678) 961-4100

NPI assigned

Nov 21, 2021

Organization subpart

No

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

Authorized official

Name

David Fidel Rodriguez, MDNPI 1376656447

Title

President

Phone

(678) 662-5190

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

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

• David F Rodriguez, M.D.

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1376656447
  Medicare reassignment NPD Authorized official
• Dora McIver Broom, PA-C

  • Physician Assistant
  • Woodstock, GA
  • NPI 1144642844
  NPD (past)
• Jay A Levin, MD

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1467406082
  NPD (past)
• Chelsie Rogers, PA-C

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1366952707
  NPD (past)

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

{
    "created_epoch": "1637452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704499200000",
    "number": "1740947035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6240 ABERDEEN DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284207",
            "telephone_number": "678-662-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD STE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421725",
            "telephone_number": "678-961-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA PERSONALIZED MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-21",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "FIDEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-662-5190",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.