NPIMap

Organization Active NPI

Premise Health of Georgia Medical, P.C.

Doing business as Boehringer Ingelheim Athens GA Occupational Health Services

  • Occupational Medicine Clinic/Center
  • Athens, GA
National Provider Identifier
1902402530
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PREMISE HEALTH OF GEORGIA MEDICAL, P.C.
Doing business as
Boehringer Ingelheim Athens GA Occupational Health Services
Practice address
1730 Olympic Dr
Athens, GA 30601-1606
Phone
(706) 552-2776
NPI assigned
Dec 9, 2020
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Dr. Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X NU Primary

Addresses

Primary practice location

1730 Olympic Dr
Athens, GA 30601-1606

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Boehringer Ingelheim Athens GA Occupational Health Services Doing business as

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
11D2145556Premise Health of Georgia Medical, PC1730 Olympic Drive, Athens, GA 30601Certificate of waiverMar 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Georgia Medical PC50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Locations

1730 Olympic Dr
Athens, GA 30601
Phone (706) 552-2776

NPI Registry JSON

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1902402530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 OLYMPIC DR",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306011606",
            "telephone_number": "706-552-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF GEORGIA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boehringer Ingelheim Athens GA Occupational Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boehringer Ingelheim Athens GA Occupational Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.