NPIMap

Organization Active NPI

Maxa Internal Medicine Associates PC

  • Primary Care Clinic/Center
  • Duluth, GA
National Provider Identifier
1902957152
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MAXA INTERNAL MEDICINE ASSOCIATES PC
Practice address
3505 Duluth Park LN
Building 4, Ste 400
Duluth, GA 30096-3201
Phone
(678) 597-3180
Fax
(678) 597-3181
NPI assigned
Jan 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

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

Authorized official

Name
Ashleigh Maxa
Title
Practice Administrator
Phone
(678) 597-3180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3505 Duluth Park LN
Building 4, Ste 400
Duluth, GA 30096-3201

Mailing address

3505 Duluth Park LN
Building 4, Ste 400
Duluth, GA 30096-3201
Phone (678) 597-3180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031114000565 GA Part B Supplier - Clinic/Group Practice 7113831017 Receives reassigned benefits from 6 practitioners
Practice locations: Duluth, GA

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
11D1015082Maxa Internal Medicine Associates PC3505 Duluth Park Lane, BDG 4 Suite 400, Duluth, GA 30096Provider-performed microscopyJul 22, 2027

National Provider Directory

National Provider Directory

Locations

3505 Duluth Park Ln
Ste 400
Duluth, GA 30096
Phone (678) 579-3180

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ACEDBA

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1902957152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 DULUTH PARK LN",
            "address_2": "BUILDING 4, STE 400",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963201",
            "telephone_number": "678-597-3180",
            "fax_number": "678-597-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 DULUTH PARK LN",
            "address_2": "BUILDING 4, STE 400",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963201",
            "telephone_number": "678-597-3180",
            "fax_number": "678-597-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXA INTERNAL MEDICINE ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "MAXA",
        "authorized_official_first_name": "ASHLEIGH",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "678-597-3180"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.