DG Sports Medicine & Wellness, LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

DG SPORTS MEDICINE & WELLNESS, LLC

Practice address

2625 Piedmont Rd NE Ste 56-435
Atlanta, GA 30324-3086

Phone

(678) 749-7020

NPI assigned

Apr 20, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Diara Gross, DONPI 1366750168

Title

Owner

Phone

(678) 595-7483

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Diara Satima Gross, D.O.

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Atlanta, GA
  • NPI 1366750168
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1902487903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 PIEDMONT RD NE STE 56-435",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 PIEDMONT RD NE STE 56-435",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243086",
            "telephone_number": "678-749-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DG SPORTS MEDICINE & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "DIARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-595-7483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry Dey, CLINICAL NURSE
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• Layla Dhabaan
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• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.