Individual provider Active NPI

Mariah Christine Pryor, AAC

  • Anesthesiologist Assistant
  • Marietta, GA
National Provider Identifier
1861555401
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
4384 Issued in GA
Practice address
677 Church St NE
Marietta, GA 30060-1101
Phone
(770) 794-0477
Fax
(770) 797-3108
NPI assigned
Dec 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 4384 GA Primary

Addresses

Primary practice location

677 Church St NE
Marietta, GA 30060-1101

Mailing address

106 Susobell PL
Woodstock, GA 30188-5102
Phone (770) 317-5987

Other practice location 1

2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Phone (770) 794-0477

Other practice location 2

8954 Hospital Dr
Douglasville, GA 30134-2272
Phone (770) 794-0477

Other practice location 3

531 Roselane St NW
Marietta, GA 30060-6913
Phone (770) 794-0477

Other practice location 4

146 Bill Carruth Pkwy
Hiram, GA 30141-3749
Phone (770) 794-0477

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929000599 GA Practitioner - Anesthesiology Assistant 0749259422 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Mak Anesthesia Holdings, LLCGroup PAC ID 4284917204, 370 clinicians

Practice addresses (Care Compare)

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
4384GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jul 1, 2022 Accepting new patients
Georgia Anesthesiologists, PC CurrentSince Sep 1, 2004 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Feb 1, 2023 Accepting new patients

Locations

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

146 Bill Carruth Pkwy
Hiram, GA 30141
Phone (770) 443-4775

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

531 Roselane St NW
Ste 830
Marietta, GA 30060
Phone (770) 658-9739

2540 Windy Hill Rd SE
Marietta, GA 30067
Phone (470) 644-1274

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

1360 Upper Hembree Rd
Ste 202
Roswell, GA 30076
Phone (404) 256-7532

3000 Hospital Blvd
Roswell, GA 30076
Phone (770) 751-2500

4500 Hospital Blvd
Ste 210
Roswell, GA 30076

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1861555401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SUSOBELL PL",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301885102",
            "telephone_number": "770-317-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-794-0477",
            "fax_number": "770-797-3108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2540 Windy Hill Rd SE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300678605",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8954 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301342272",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "531 Roselane St NW",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300606913",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "146 Bill Carruth Pkwy",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301413749",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRYOR",
        "first_name": "MARIAH",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "AAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "4384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; 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.