Illuminate Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ILLUMINATE MEDICAL LLC

Practice address

5257 Bowman Springs TRL
Flowery Branch, GA 30542-5193

Phone

(470) 846-3790

NPI assigned

Jul 26, 2024

Organization subpart

No

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

Authorized official

Name

Seth M Illu, MDNPI 1043960396

Title

President

Phone

(470) 846-3790

Specialties & licenses 1

Addresses

Practitioners 1

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

• Seth M. Illu, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Salt Lake City, UT
  • NPI 1043960396
  NPD Authorized official

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1831928126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5257 BOWMAN SPRINGS TRL",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305425193",
            "telephone_number": "470-846-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5257 BOWMAN SPRINGS TRL",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305425193",
            "telephone_number": "470-846-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "ILLU",
        "authorized_official_first_name": "SETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "470-846-3790",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Flowery Branch, GA
• Providers in Flowery Branch, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; 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.