Providence Rd Primary Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

64774 Issued in GA

Legal business name

PROVIDENCE RD PRIMARY CARE LLC

Practice address

4180 Providence Rd
Ste 105
Marietta, GA 30062-6186

Phone

(770) 973-4749

Fax

(770) 973-4349

NPI assigned

Jun 5, 2013

Organization subpart

No

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

Authorized official

Name

Amma Abunyewa, MDNPI 1982932745

Title

Provider

Phone

(770) 973-4749

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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

• Amma Abunyewa, M.D.

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1982932745
  Medicare reassignment NPD Authorized official
• Bernard G Taylor, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1356441737
  NPD (past)
• Charles Abunyewa, M.D

  • Internal Medicine Physician
  • Cleveland, OH
  • NPI 1942238605
  NPD (past)

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1831537539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4180 PROVIDENCE RD",
            "address_2": "STE 105",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626186",
            "telephone_number": "770-973-4749",
            "fax_number": "770-973-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4180 PROVIDENCE RD",
            "address_2": "STE 105",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626186",
            "telephone_number": "770-973-4749",
            "fax_number": "770-973-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE RD PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "ABUNYEWA",
        "authorized_official_first_name": "AMMA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "770-973-4749",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "64774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Allex Provens, MA
• Providence Dental Spa of East Cobb, LLC
• Kaynessa Celena Providence, M.D.
• Provident Healthcare LLC
• Sandra L Pruett, CNP
• Lashanti Melba Pruitt, MA
• Pruitthealth - Marietta, LLC

• Internal Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.