NPIMap

Organization Active NPI

Family Practice of Atlanta LLC

  • Primary Care Clinic/Center
  • Decatur, GA
National Provider Identifier
1790966976
Registry record updated Mar 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
031294 Issued in GA
Legal business name
FAMILY PRACTICE OF ATLANTA LLC
Practice address
1428 Scott Blvd
Decatur, GA 30030-1424
Phone
(404) 296-8100
Fax
(404) 294-8467
NPI assigned
Nov 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2010

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

Authorized official

Name
Dr. Sondi Saddia Moore-Waters, M.D.NPI 1508941501
Title
Medical Director
Phone
(404) 296-8100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 031294 GA Primary

Addresses

Primary practice location

1428 Scott Blvd
Decatur, GA 30030-1424

Mailing address

1428 Scott Blvd
Decatur, GA 30030-1424
Phone (404) 296-8100

Other identifiers 1

IdentifierTypeStateIssuer
GRP6402OtherGAMEDICARE GROUP

National Provider Directory

National Provider Directory

Locations

487 Winn Way
Ste 209
Decatur, GA 30030
Phone (404) 296-8100

1428 Scott Blvd
Decatur, GA 30030
Phone (404) 270-9242

Practitioners & affiliated clinicians

Practitioners 6

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": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267660800000",
    "number": "1790966976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 SCOTT BLVD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301424",
            "telephone_number": "404-296-8100",
            "fax_number": "404-294-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 SCOTT BLVD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301424",
            "telephone_number": "404-296-8100",
            "fax_number": "404-294-8467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE OF ATLANTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2010-03-04",
        "status": "A",
        "authorized_official_last_name": "MOORE-WATERS",
        "authorized_official_first_name": "SONDI",
        "authorized_official_middle_name": "SADDIA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-296-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "031294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GRP6402",
            "state": "GA"
        }
    ],
    "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 Mar 4, 2010; 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.