NPIMap

Organization Active NPI

Infectious Disease Services of Georgia PC

  • Infectious Disease Physician
  • Roswell, GA
National Provider Identifier
1831236728
Registry record updated Jun 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
INFECTIOUS DISEASE SERVICES OF GEORGIA PC
Practice address
11660 Alpharetta Hwy
Suite 430
Roswell, GA 30076-4943
Phone
(770) 255-1069
Fax
(770) 255-1075
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2024

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

Authorized official

Name
Ms. Emily Chism
Title
Billing Department
Phone
(770) 255-1069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

11660 Alpharetta Hwy
Suite 430
Roswell, GA 30076-4943

Mailing address

11660 Alpharetta Hwy
Suite 430
Roswell, GA 30076-4943
Phone (770) 255-1069

Other identifiers 1

IdentifierTypeStateIssuer
003233274AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050208000867 GA Part B Supplier - Clinic/Group Practice 3072564954 Receives reassigned benefits from 14 practitioners
Practice locations: Cumming, GA; Johns Creek, GA; Roswell, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1037754Infectious Disease Services of Georgia PC11660 Alpharetta Highway, Suite 430, Roswell, GA 30076Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Infectious Disease Serv of Georgia2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15 Reinhardt College Pkwy
Ste 102
Canton, GA 30114
Phone (678) 505-4455

1405 Haw Creek Cir E
Cumming, GA 30041

1100 Northside Forsyth Dr
Ste 250
Cumming, GA 30041
Phone (770) 517-6636

6335 Hospital Pkwy
Ste 310
Johns Creek, GA 30097
Phone (678) 551-6970

3890 Johns Creek Pkwy
Ste 180
Suwanee, GA 30024
Phone (678) 551-6970

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717891200000",
    "number": "1831236728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11660 ALPHARETTA HWY",
            "address_2": "SUITE 430",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764943",
            "telephone_number": "770-255-1069",
            "fax_number": "770-255-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11660 ALPHARETTA HWY",
            "address_2": "SUITE 430",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764943",
            "telephone_number": "770-255-1069",
            "fax_number": "770-255-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFECTIOUS DISEASE SERVICES OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-06-09",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "CHISM",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "BILLING DEPARTMENT",
        "authorized_official_telephone_number": "770-255-1069",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003233274A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.