South Atlanta Digestive Diseases Associates

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

048686 Issued in GA

Legal business name

SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES

Practice address

1151 Cleveland Ave
Suite D
East Point, GA 30344-3600

Phone

(404) 761-7949

Fax

(404) 761-7386

NPI assigned

Mar 10, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Petronilla C Okere

Title

Office Aministrator

Phone

(404) 761-7949

Specialties & licenses 4

Addresses

Other identifiers 2

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

Locations

Practitioners 1

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

• Charles N. Okolo, M.D.

  • Gastroenterology Physician
  • East Point, GA
  • NPI 1104897024
  Medicare reassignment NPD

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

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1841460490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 CLEVELAND AVE",
            "address_2": "SUITE D",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443600",
            "telephone_number": "404-761-7949",
            "fax_number": "404-761-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 CLEVELAND AVE",
            "address_2": "SUITE D",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443600",
            "telephone_number": "404-761-7949",
            "fax_number": "404-761-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "OKERE",
        "authorized_official_first_name": "PETRONILLA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE AMINISTRATOR",
        "authorized_official_telephone_number": "404-761-7949",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "048686",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "048686",
            "primary": true
        },
        {
            "code": "207RI0008X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hepatology",
            "state": "GA",
            "license": "048686",
            "primary": false
        },
        {
            "code": "207RT0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Transplant Hepatology",
            "state": "GA",
            "license": "048686",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000893483C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "003089",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davaughan Smith
• Valerie Smith, DDS
• Sobek, LLC
• Sound Physicians of Georgia III PC
• South Atlant Medical& Rehabilitation, L.L.C.
• South Atlanta Medical Associates PC
• South Atlanta Medical Associates, PC
• South Atlanta Pulmonary Group
• South Atlanta Spine and Wellness Center
• South Fulton Dermatology Associates,LLP

• Gastroenterology Physician in East Point, GA
• Providers in East Point, GA by specialty
• Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.