NPIMap

Organization Active NPI

Peace Health Family Medical Center

  • Family Medicine Physician
  • Riverdale, GA
National Provider Identifier
1841404589
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PEACE HEALTH FAMILY MEDICAL CENTER
Practice address
653 Roberts Dr
Sutie a
Riverdale, GA 30274-2959
Phone
(770) 907-8400
Fax
(770) 907-8430
NPI assigned
May 10, 2007
Last updated
May 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Authorized official

Name
Karen Scott
Title
Practice Administrator
Phone
(770) 907-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

653 Roberts Dr
Sutie a
Riverdale, GA 30274-2959

Mailing address

653 Roberts Dr
Riverdale, GA 30274-2959
Phone (770) 907-8400

Other identifiers 4

IdentifierTypeStateIssuer
00441955GOtherGAGEORGIA MEDICAID
116691OtherGAPEACH STATE
00441955GMedicaidGA
52264408OtherGABLUE CROSS BLUE SHIEL OF GEORGIA

National Provider Directory

National Provider Directory

Locations

653 Roberts Dr
Riverdale, GA 30274

653 Roberts Dr
Ste A
Riverdale, GA 30274
Phone (770) 907-8400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1841404589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 ROBERTS DR",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742959",
            "telephone_number": "770-907-8400",
            "fax_number": "770-907-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 ROBERTS DR",
            "address_2": "SUTIE A",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742959",
            "telephone_number": "770-907-8400",
            "fax_number": "770-907-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE HEALTH FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-907-8400"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA MEDICAID",
            "identifier": "00441955G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE",
            "identifier": "116691",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00441955G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIEL OF GEORGIA",
            "identifier": "52264408",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.