Active NPI
Aegis Group Practice LLC
- Physical Therapist
- Marietta, GA
National Provider Identifier
1780229740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 9 Sherwood LN SE
Marietta, GA 30067-4035 - Phone
- (800) 444-6845
- NPI assigned
- Nov 14, 2019
- Last updated
- Nov 14, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael McOlvin
- Title
- VP-Finance
- Phone
- (479) 201-2000
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | Primary | |
| Occupational Therapist | 225X00000X | NU | ||
| Speech-Language Pathologist | 235Z00000X | NU |
Addresses
Primary practice location
9 Sherwood LN SE
Marietta, GA 30067-4035
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150916001644 | GA | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 34 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Canton, GA; Suwanee, GA |
Other NPIs on the same Medicare enrollment 37
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573689600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1573689600000",
"number": "1780229740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 NETWORK BLVD STE 102",
"city": "FRISCO",
"state": "TX",
"postal_code": "750349092",
"telephone_number": "972-372-6779",
"fax_number": "479-668-0872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 SHERWOOD LN SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300674035",
"telephone_number": "800-444-6845"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-14",
"last_updated": "2019-11-14",
"status": "A",
"authorized_official_last_name": "MCOLVIN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "VP-FINANCE",
"authorized_official_telephone_number": "479-201-2000"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
- Advanced Urology Institute of Georgia, LLC
- Advanta Medical & Physical Therapy
- Advanta Medical & Physical Therapy PC (Advanta Total Health)
- Peter K Adzudzor, MA
- Aegis Group Practice LLC
- Afc Physicians of Georgia Urgent Care, PC
- Afc Physicians of Georgia, PC (AFC Physicians of GA, PC)
- Affordable Medical Resources, Inc.
- Jennifer Afman, CNM
- Aga, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; 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.