Khemaporn Lertdetkajorn, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

100193 Issued in GA

Practice address

33 Upper Riverdale Rd SW Ste 111
Riverdale, GA 30274-2642

Phone

(770) 909-2045

Fax

(770) 909-2056

NPI assigned

Jul 8, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Endocrinology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Regional Physicians Management Group, LLCGroup PAC ID 9032491956, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southern Regional Medical Center Hospital, Riverdale, GA, CCN 110165

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: khemaporn.lertdetkajorn.1@18552.direct.athenahealth.com

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.

• Southern Regional Physicians Management Group, LLC

  • Surgery Physician
  • Riverdale, GA
  • NPI 1043677271
  Medicare reassignment Care Compare group NPD

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

• Prime Healthcare Foundation - Southern Regional, LLC

  • General Acute Care Hospital
  • Riverdale, GA
  • NPI 1154795581
  Care Compare affiliation

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

{
    "created_epoch": "1531008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1871089367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 UPPER RIVERDALE RD SW STE 111",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742642",
            "telephone_number": "770-909-2045",
            "fax_number": "770-909-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 UPPER RIVERDALE RD SW STE 111",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742642",
            "telephone_number": "770-909-2045",
            "fax_number": "770-909-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERTDETKAJORN",
        "first_name": "KHEMAPORN",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-08",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "GA",
            "license": "100193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charnise Lashae Lee
• Moo Hee Lee, MD
• Legacy Brain & Spine LLC
• Legacy Center for Spinal Surgery- Riverdale LLC
• Legacy Primary Care and Wellness
• Rodney Fitzgerald Lester Jr.
• Jennifer Leverett, PHARM.D.
• Brittany Lewis
• Jacob Dwayne Lewis
• Lexok Consulting

• Endocrinology, Diabetes & Metabolism Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.