Jubilee Primary Care PC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

JUBILEE PRIMARY CARE PC

Practice address

3312 Heathchase LN
Suwanee, GA 30024-4639

Phone

(678) 783-4860

Fax

(678) 940-0509

NPI assigned

Oct 12, 2020

Organization subpart

No

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

Authorized official

Name

Avril Patrice Daisley Shongo, MDNPI 1013965961

Title

Provider

Phone

(678) 783-4860

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Avril Patrice Daisley Shongo, MD

  • Family Medicine Physician
  • Suwanee, GA
  • NPI 1013965961

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1891393005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 LAWRENCEVILLE SUWANEE RD",
            "address_2": "SUITE A#519",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "678-783-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 HEATHCHASE LN",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244639",
            "telephone_number": "678-783-4860",
            "fax_number": "678-940-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUBILEE PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "SHONGO",
        "authorized_official_first_name": "AVRIL PATRICE",
        "authorized_official_middle_name": "DAISLEY",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "678-783-4860",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Family Medicine) Physician in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Addiction Medicine (Family Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.