NPIMap

Organization Active NPI

United Physician Group LLC

  • Family Medicine Physician
  • Brookhaven, GA
National Provider Identifier
1922579192
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNITED PHYSICIAN GROUP LLC
Practice address
13 Corporate Blvd NE Ste 100
Brookhaven, GA 30329-1905
Phone
(678) 505-9657
NPI assigned
Dec 16, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Christian Fletcher
Title
Ceo
Phone
(833) 523-0906

Practitioners 27

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

View all 27

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190314000835 GA Part B Supplier - Clinic/Group Practice 7113267956 Receives reassigned benefits from 10 practitioners
Practice locations: Brookhaven, GA; Conyers, GA; Decatur, GA; Douglasville, GA; Hampton, GA; Lithonia, GA
O20190819002205 SC Part B Supplier - Clinic/Group Practice 7113267956 Receives reassigned benefits from 17 practitioners
Practice locations: Myrtle Beach, SC; Spartanburg, SC; Piedmont, SC; Greenville, SC; Easley, SC; Columbia, SC

National Provider Directory

National Provider Directory

Locations

52 Bear Dr
Ste G
Greenville, SC 29605
Phone (864) 671-6492

52 Bear Dr
Greenville, SC 29605
Phone (864) 295-2131

116 Commons Blvd
Piedmont, SC 29673
Phone (864) 671-6492

116 Commons Blvd
Ste 100
Piedmont, SC 29673

116 Commons Blvd
Ste 220
Piedmont, SC 29673
Phone (864) 671-6492

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

13 Corporate Blvd NE Ste 100
Brookhaven, GA 30329-1905

Mailing address

13 Corporate Blvd NE Ste 100
Brookhaven, GA 30329-1905
Phone (678) 505-9657

Other practice location 1

1862 Candler Rd
Decatur, GA 30032-4163
Phone (678) 672-4093

Other practice location 2

8052 Mall Pkwy Ste 103
Lithonia, GA 30038-2649
Phone (404) 289-4556

Other practice location 3

116 Commons Blvd Ste 220
Piedmont, SC 29673-7766
Phone (864) 671-6492

Other practice location 4

8203 Nigels Dr
Myrtle Beach, SC 29572-4177
Phone (864) 671-6492

Other practice location 5

7201 Brookfield Rd
Columbia, SC 29223-2215
Phone (803) 736-4050

Other practice location 6

3970 Five Forks Trickum Rd SW Ste A
Lilburn, GA 30047-2339
Phone (855) 359-8629

Other practice location 7

1039 E Freeway Dr SE
Conyers, GA 30094-5965
Phone (770) 922-0076

Other practice location 8

52 Bear Dr
Greenville, SC 29605-4458
Phone (864) 671-6492

Other practice location 9

1650 Skylyn Dr Ste 210
Spartanburg, SC 29307-1069
Phone (864) 671-6492

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Other URL unitedphysiciangroup.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 15, 2020.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1922579192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 CORPORATE BLVD NE STE 100",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291905",
            "telephone_number": "678-505-9657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CORPORATE BLVD NE STE 100",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291905",
            "telephone_number": "678-505-9657"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1862 Candler Rd",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300324163",
            "country_code": "US",
            "telephone_number": "678-672-4093",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8052 Mall Pkwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "Lithonia",
            "state": "GA",
            "postal_code": "300382649",
            "country_code": "US",
            "telephone_number": "404-289-4556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "116 Commons Blvd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Piedmont",
            "state": "SC",
            "postal_code": "296737766",
            "country_code": "US",
            "telephone_number": "864-671-6492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8203 Nigels Dr",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295724177",
            "country_code": "US",
            "telephone_number": "864-671-6492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7201 Brookfield Rd",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292232215",
            "country_code": "US",
            "telephone_number": "803-736-4050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3970 Five Forks Trickum Rd SW Ste A",
            "address_purpose": "LOCATION",
            "city": "Lilburn",
            "state": "GA",
            "postal_code": "300472339",
            "country_code": "US",
            "telephone_number": "855-359-8629",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1039 E Freeway Dr SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300945965",
            "country_code": "US",
            "telephone_number": "770-922-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 Bear Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054458",
            "country_code": "US",
            "telephone_number": "864-671-6492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Skylyn Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293071069",
            "country_code": "US",
            "telephone_number": "864-671-6492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNITED PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "833-523-0906",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "unitedphysiciangroup.com",
            "affiliation": "N",
            "address_1": "13 Corporate Blvd NE Ste 100",
            "city": "Brookhaven",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303291905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brookhaven, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.