NPIMap

Organization Active NPI

Undeniable Healthcare

  • Family Medicine Physician
  • Peachtree City, GA
National Provider Identifier
1871062489
Registry record updated Dec 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNDENIABLE HEALTHCARE
Practice address
1280 Highway 74 S Ste 100
Peachtree City, GA 30269-3077
Phone
(678) 961-5150
Fax
(678) 559-0789
NPI assigned
Nov 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2023

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

Authorized official

Name
Mr. Tie Sims, NP
Title
Ceo
Phone
(678) 961-5150

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Podiatric Clinic/Center 261QP1100X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

1280 Highway 74 S Ste 100
Peachtree City, GA 30269-3077

Mailing address

1280 Highway 74 S Ste 100
Peachtree City, GA 30269-3077
Phone (678) 961-5150

Other practice location 1

5370 Campbellton Fairburn Rd Ste 430
Fairburn, GA 30213-2296
Phone (678) 545-1881

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Www.undeniablehealthcare.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220629000159 GA Part B Supplier - Clinic/Group Practice 7012397615 Receives reassigned benefits from 11 practitioners
Practice locations: Peachtree City, GA; Fairburn, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2160529Undeniable Healthcare1280 Highway 74 S, Suite 100, Peachtree City, GA 30269Certificate of waiverJan 13, 2027

National Provider Directory

National Provider Directory

Locations

5370 Campbellton Fairburn Rd
Ste 430
Fairburn, GA 30213
Phone (678) 545-1881

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24615/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703980800000",
    "number": "1871062489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 HIGHWAY 74 S STE 100",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693077",
            "telephone_number": "678-961-5150",
            "fax_number": "678-559-0789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 HIGHWAY 74 S STE 100",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693077",
            "telephone_number": "678-961-5150",
            "fax_number": "678-559-0789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5370 Campbellton Fairburn Rd Ste 430",
            "address_purpose": "LOCATION",
            "city": "Fairburn",
            "state": "GA",
            "postal_code": "302132296",
            "country_code": "US",
            "telephone_number": "678-545-1881",
            "fax_number": "678-559-0789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNDENIABLE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2023-12-31",
        "certification_date": "2023-12-31",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "TIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-961-5150",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.undeniablehealthcare.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "address_1": "1280 Highway 74 S Ste 100",
            "city": "Peachtree City",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302693077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2023; 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.