Southern Crescent Primary Care

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

039193 Issued in GA

Legal business name

SOUTHERN CRESCENT PRIMARY CARE

Practice address

7823 Spivey Station Blvd
Suite 210
Jonesboro, GA 30236-2886

Phone

(678) 610-2916

Fax

(678) 610-2925

NPI assigned

Jun 3, 2008

Organization subpart

No

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

Authorized official

Name

John Olubusola Ogundipe, MD,PHD,CMD

Title

Physician/President

Phone

(678) 610-2916

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1922267129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7823 SPIVEY STATION BLVD",
            "address_2": "SUITE 210",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362886",
            "telephone_number": "678-610-2916",
            "fax_number": "678-610-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7823 SPIVEY STATION BLVD",
            "address_2": "SUITE 210",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362886",
            "telephone_number": "678-610-2916",
            "fax_number": "678-610-2925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "OGUNDIPE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "OLUBUSOLA",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "678-610-2916",
        "authorized_official_credential": "MD,PHD,CMD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "039193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000639768B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110239410",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Atlanta Primary Care PC
• Southern Crescent Home Care
• Southern Crescent Medical Clinic, Inc.
• Southern Crescent Physicians Group, Inc.
• Southern Crescent Physicians Group, Inc.
• Southern Creseant Surgical Assistants
• Southlake Ambulatory Surgery Center, LLLP
• Southmetro Chiropractic Center, Inc
• Southside Medical Center, Inc
• Jasmin Spencer

• Internal Medicine Physician in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; 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.