NPIMap

Organization Active NPI

Eagle Drive Family Medicine PC

  • General Practice Physician
  • Woodstock, GA
National Provider Identifier
1750514295
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EAGLE DRIVE FAMILY MEDICINE PC
Practice address
1816 Eagle Dr
Suite 200-B
Woodstock, GA 30189-8272
Phone
(678) 445-5995
NPI assigned
Sep 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Authorized official

Name
Richard Leon Manrique, M.D.NPI 1548299332
Title
President
Phone
(678) 445-5995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1816 Eagle Dr
Suite 200-B
Woodstock, GA 30189-8272

Mailing address

1816 Eagle Dr
Suite 200-B
Woodstock, GA 30189-8272
Phone (678) 445-5995

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1750514295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "SUITE 200-B",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "678-445-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "SUITE 200-B",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "678-445-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE DRIVE FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-01",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "MANRIQUE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-445-5995",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; 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.