NPIMap

Organization Active NPI

Fairburn Southpark Medical and Surgical Clinic

  • Clinic/Center
  • Fairburn, GA
National Provider Identifier
1780739318
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
FAIRBURN SOUTHPARK MEDICAL AND SURGICAL CLINIC
Practice address
204 Senoia Rd
Fairburn, GA 30213-1536
Phone
(770) 964-9759
Fax
(770) 964-7001
NPI assigned
Jan 24, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Renato Chaves Souza, MDNPI 1689607269
Title
President Treasurer
Phone
(770) 964-9759

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

204 Senoia Rd
Fairburn, GA 30213-1536

Mailing address

204 Senoia Rd
Fairburn, GA 30213-1536
Phone (770) 964-9759

Other names 1

  • r.c.souza, md,pc Former legal business name

National Provider Directory

National Provider Directory

Locations

204 Senoia Rd
Fairburn, GA 30213
Phone (770) 964-9759

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780739318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SENOIA RD",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302131536",
            "telephone_number": "770-964-9759",
            "fax_number": "770-964-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SENOIA RD",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302131536",
            "telephone_number": "770-964-9759",
            "fax_number": "770-964-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBURN SOUTHPARK MEDICAL AND SURGICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOUZA",
        "authorized_official_first_name": "RENATO",
        "authorized_official_middle_name": "CHAVES",
        "authorized_official_title_or_position": "PRESIDENT TREASURER",
        "authorized_official_telephone_number": "770-964-9759",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "r.c.souza, md,pc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fairburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.