NPIMap

Organization Active NPI

Sports Medicine South, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Lawrenceville, GA
National Provider Identifier
1780860924
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
040138 Issued in GA
Legal business name
SPORTS MEDICINE SOUTH, LLC
Practice address
1900 Riverside Pkwy
Lawrenceville, GA 30043-5925
Phone
(770) 237-3475
Fax
(770) 237-3756
NPI assigned
Jan 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

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

Authorized official

Name
Dr. Gary A Levengood, M.D.
Title
Owner
Phone
(770) 237-3475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X 040138 GA Primary

Addresses

Primary practice location

1900 Riverside Pkwy
Lawrenceville, GA 30043-5925

Mailing address

1900 Riverside Pkwy
Lawrenceville, GA 30043-5925
Phone (770) 237-3475

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.

NPI Registry JSON

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1780860924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RIVERSIDE PKWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435925",
            "telephone_number": "770-237-3475",
            "fax_number": "770-237-3756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 RIVERSIDE PKWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435925",
            "telephone_number": "770-237-3475",
            "fax_number": "770-237-3756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE SOUTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "LEVENGOOD",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-237-3475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "040138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; 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.