NPIMap

Organization Active NPI

Vituity-Georgia Intensivists PC

  • Internal Medicine Physician
  • Decatur, GA
National Provider Identifier
1770348500
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
VITUITY-GEORGIA INTENSIVISTS PC
Practice address
450 N Candler St
Decatur, GA 30030-2626
Phone
(404) 501-6100
NPI assigned
Feb 20, 2024
Last updated
Jul 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Authorized official

Name
Theophile G. KouryNPI 1568483691
Title
President
Phone
(510) 350-2600

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

450 N Candler St
Decatur, GA 30030-2626

Mailing address

2100 Powell St Ste 400
Emeryville, CA 94608-1872
Phone (510) 350-2600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240502001573 GA Part B Supplier - Clinic/Group Practice 8820438229 Receives reassigned benefits from 8 practitioners
Practice locations: Decatur, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1708387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1770348500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST STE 400",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081872",
            "telephone_number": "510-350-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N CANDLER ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302626",
            "telephone_number": "404-501-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITUITY-GEORGIA INTENSIVISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "KOURY",
        "authorized_official_first_name": "THEOPHILE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-350-2600"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.