Relymd Medical Group Ga, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

RELYMD MEDICAL GROUP GA, LLC

Practice address

900 Old Roswell Lakes Pkwy Ste 310
Roswell, GA 30076-8667

Phone

(919) 932-0928

NPI assigned

Aug 19, 2020

Organization subpart

Yes

Parent organization

RELYMD MEDICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Ronald Michael Creatore

Title

Cfo/General Counsel

Phone

(919) 932-0928

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RelyMD Medical Group Doing business as

Part of

Relymd Medical Group LLC

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1962014118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 MEADOWMONT VILLAGE CIR STE 323",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275177584",
            "telephone_number": "919-932-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 OLD ROSWELL LAKES PKWY STE 310",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300768667",
            "telephone_number": "919-932-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELYMD MEDICAL GROUP GA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RELYMD MEDICAL GROUP, LLC",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "CREATORE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO/GENERAL COUNSEL",
        "authorized_official_telephone_number": "919-932-0928"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA SECRETARY OF STATE",
            "identifier": "20140276",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RelyMD Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RelyMD Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Roswell, GA
• Providers in Roswell, 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 Aug 26, 2020; 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.