Individual provider Active NPI

Fidias Eduardo De Leon, M.D.

  • General Practice Physician
  • Decatur, GA
National Provider Identifier
1871756155
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
63891 Issued in GA
Practice address
1670 Clairmont Rd
Decatur, GA 30033-4004
Phone
(044) 321-6111
NPI assigned
Jul 7, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Cardiology Physician 207UN0901X 63891 GA
Nuclear Imaging & Therapy Physician 207UN0902X 63891 GA
General Practice Physician 208D00000X ME104760 FL
General Practice Physician 208D00000X 63891 GA Primary

Addresses

Primary practice location

1670 Clairmont Rd
Decatur, GA 30033-4004

Mailing address

1670 Clairmont Rd
Decatur, GA 30033-4004
Phone (044) 321-6111

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20121024000231 GA Practitioner - General PracticePractitioner - Nuclear Medicine 6507909835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Nuclear Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peachtree Immediate Care FP, LLCGroup PAC ID 3274559323, 328 clinicians

Practice addresses (Care Compare)

1220 Caroline St NE
Suite a 230
Atlanta, GA 30307-2749
Phone (678) 710-3980

1829 Lawrenceville Hwy
Decatur, GA 30033-5728
Phone (404) 292-8335

1834 Clairmont Rd
Suite 100
Decatur, GA 30033-3405
Phone (404) 634-4443

3551 Satellite Blvd
Duluth, GA 30096-4646
Phone (770) 476-3000

3720 Holcomb Bridge Rd
Norcross, GA 30092-4795
Phone (770) 263-1000

3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2804
Phone (770) 222-8900

3991 Hwy 78 W
Snellville, GA 30039-3929
Phone (678) 786-8677

4327 Hugh Howell Rd
Tucker, GA 30084-4739
Phone (678) 800-1279

4575 Roswell Rd
Suite 100
Sandy Springs, GA 30342-3101
Phone (678) 539-9797

500 Great Oaks Dr
Suite 9
Monroe, GA 30655-8228
Phone (678) 905-9121

5419 Chamblee Dunwoody Rd
Dunwoody, GA 30338-4101
Phone (678) 284-2067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63891GAMDNuclear Imaging & Therapy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet of Georgia PC CurrentSince Jun 28, 2023 Accepting new patients
Peachtree Immediate Care FP, LLC CurrentSince Feb 1, 2016 Accepting new patients

Locations

3540 Cobb Pkwy NW
Acworth, GA 30101
Phone (770) 974-3911

10905 Haynes Bridge Rd
Alpharetta, GA 30022
Phone (770) 343-9898

2701 Holcomb Bridge Rd
Alpharetta, GA 30022
Phone (404) 327-8744

2700 Clairmont Rd NE
Atlanta, GA 30329
Phone (404) 327-8744

3425 Buford Dr
Ste 200
Buford, GA 30519
Phone (678) 546-0200

9390 The Landing Dr
Douglasville, GA 30135
Phone (770) 947-1112

3551 Satellite Blvd
Duluth, GA 30096
Phone (770) 476-3000

590 Lanier Ave W
Fayetteville, GA 30214

1275 Highway 54 W
Ste 201
Fayetteville, GA 30214
Phone (770) 461-3776

3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900

2481 George Busbee Pkwy NW
Kennesaw, GA 30144
Phone (770) 423-0000

3330 Sugarloaf Pkwy
Ste A
Lawrenceville, GA 30044
Phone (404) 480-9797

3720 Holcomb Bridge Rd
Peachtree Corners, GA 30092
Phone (770) 263-1000

3641 Centerville Hwy
Snellville, GA 30039
Phone (770) 752-4141

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1871756155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300334004",
            "telephone_number": "044-321-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300334004",
            "telephone_number": "044-321-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LEON",
        "first_name": "FIDIAS",
        "middle_name": "EDUARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "GA",
            "license": "63891",
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "GA",
            "license": "63891",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME104760",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "63891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.