E Edward Proctor, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

32976 Issued in GA

Practice address

755 Walther Rd
Lawrenceville, GA 30045

Phone

(770) 962-0399

Fax

(770) 995-0533

NPI assigned

Sep 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gwinnett Medical Group, Inc

  • General Practice Physician
  • Lawrenceville, GA
  • NPI 1780747469
  NPD
• Gwinnett Pathology Assoc PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Lawrenceville, GA
  • NPI 1104887330
  NPD
• Cardiovascular Group, PC

  • Cardiovascular Disease Physician
  • Lawrenceville, GA
  • NPI 1215980479
  NPD (past)
• Saint Josephs Hospital of Atlanta Inc

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1679664395
  NPD (past)

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1790771103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 WALTHER RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458725",
            "telephone_number": "770-962-0399",
            "fax_number": "770-995-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 WALTHER RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30045",
            "telephone_number": "770-962-0399",
            "fax_number": "770-995-0533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "755 Walther Rd",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "30045",
            "country_code": "US",
            "telephone_number": "770-962-0399",
            "fax_number": "770-995-0533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "E",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "32976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00430328C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prism Distributions LLC
• Payton Marie Pritchard, OTR/L
• Pro Care EMS, LLC
• Pro-Hands Home & Health Services
• Proactive MD Ga, LLC
• Marilyn Proctor, MS ED
• Melanie Kim Proctor, LMSW
• Professional and Quality Homecare
• Professional Care Nursing Agency LLC
• Professional Medical Services Inc.

• Cardiovascular Disease Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Cardiovascular Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; 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.