South Forsyth Family Medicine and Pediatrics LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2401782 Issued in GA

Legal business name

SOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC

Practice address

1845 Lockeway Dr
Suite 404
Alpharetta, GA 30004-5936

Phone

(770) 343-9112

Fax

(770) 343-8911

NPI assigned

Oct 9, 2007

Last updated

Jan 17, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Dina J Gore

Title

Medical Billing & Insurance Manager

Phone

(770) 343-9112

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

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

Practitioners 5

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.

• David Samuel Boaz, M.D.

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1750305124
  Medicare reassignment Care Compare group NPD
• Mark Glodener, MD

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1174629885
  Medicare reassignment Care Compare group NPD
• Giouzel Glodener, M.D.

  • Specialist
  • Alpharetta, GA
  • NPI 1528046539
  NPD (past)
• Jackleen Marie Glodener, DO

  • Pediatrics Physician
  • Alpharetta, GA
  • NPI 1780266270
  NPD (past)
• Kyle B Pepple, D.C.

  • Chiropractor
  • Cumming, GA
  • NPI 1821075896
  NPD (past)

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1952599516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 LOCKEWAY DR",
            "address_2": "SUITE 404",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300045936",
            "telephone_number": "770-343-9112",
            "fax_number": "770-343-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 LOCKEWAY DR",
            "address_2": "SUITE 404",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300045936",
            "telephone_number": "770-343-9112",
            "fax_number": "770-343-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "DINA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL BILLING & INSURANCE MANAGER",
        "authorized_official_telephone_number": "770-343-9112",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "2401782",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "2401782",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000630759E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000630759F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonant Therapy Group LLC (Sweet Talkers)
• Edward John Sons, CSA
• Lina Sorokin
• Soteria Healthcare Network, Inc.
• Soul Medical Transport LLC
• South Forsyth Wellness LLC
• Southeast Medical Group, P.C. (North Atlanta Primary Care, P.C.)
• Southeast Medical Group, P.C.
• Southeast Oral Diagnostics LLC
• Southeast Primary Care Medical Group - Alabama LLC

• Family Medicine Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; 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.