Amy Jordan Eubanks, M.D.
Individual provider Active NPI Internal Medicine Physician · Bremen, GA
NPI 1962441493 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1962441493
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 052922 (GA)
- Practice address
- 204 Allen Memorial Dr Ste 201
Bremen, GA 30110-2062 - Phone
- (770) 537-6500
- Fax
- (770) 824-2600
- NPI assigned
- Jun 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Medical College of Georgia School of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- TMC Haralson Family Healthcare Center
Practice addresses (Care Compare)
204 Allen Memorial Dr
Suite 201
Bremen, GA 30110-2062
Phone (770) 537-6500
Hospital & facility affiliations
- Tanner Home Health Services
- Centerwell Home Health
- Tanner Medical Center Villa Rica
- Tanner Medical Center - Carrollton
- Higgins General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040811000372 | GA | Practitioner - Internal Medicine | 2961474861 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052922 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanner Medical Group Inc | Internal Medicine | Current |
Accepting new patients |
| TMC Haralson Family Healthcare Center | Current |
Accepting new patients |
Locations
204 Allen Memorial Dr
Ste 201
Bremen, GA 30110
Phone (770) 537-6500
157 Clinic Ave
Ste 302A
Carrollton, GA 30117
Phone (770) 812-5886
706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825
119 Ambulance Dr
Ste 202
Carrollton, GA 30117
Phone (770) 838-8710
101 Quartz Dr
Ste 201
Villa Rica, GA 30180
Phone (770) 456-3839
690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 052922 | GA | Yes |
Addresses
Primary practice location
204 Allen Memorial Dr Ste 201
Bremen, GA 30110-2062
Mailing address
119 Ambulance Dr
Suite 202
Carrollton, GA 30117-3857
Phone (770) 838-8710
Other names
- Amy Elizabeth Jordan
Other providers in Bremen, GA
- Joseph Cameron Entrekin
- Joseph Chandler Entrekin
- Kelley Entrekin
- Eric S. Leithner, DMD, PC
- Alyssa Morgan Eriquezzo
- David Farmer
- Christina Fischer
- Lori Fuller
- Sharon Garland
- Victoria Garner
All providers in Bremen, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.