NPIMap

Organization Active NPI

Park Springs, LLC

Doing business as Park Springs Wellness Clinic

  • Health Service Clinic/Center
  • Stone Mountain, GA
National Provider Identifier
1962628669
Registry record updated Jul 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
PARK SPRINGS, LLC
Doing business as
Park Springs Wellness Clinic
Practice address
500 Springhouse Cir
Stone Mountain, GA 30087-6718
Phone
(770) 879-4330
Fax
(678) 684-3066
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2017

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

Authorized official

Name
Kevin W Isakson
Title
Managing Partner
Phone
(404) 932-6552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

500 Springhouse Cir
Stone Mountain, GA 30087-6718

Mailing address

500 Springhouse Cir
Stone Mountain, GA 30087-6718
Phone (770) 879-4330

Other names 1

  • PARK SPRINGS WELLNESS CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041203000292 GA Part B Supplier - Clinic/Group Practice 7810961380 Receives reassigned benefits from 8 practitioners
Practice locations: Stone Mountain, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Park Springs, LLC

    dba Pebblebrook Health Center at Park Springs

    • Skilled Nursing Facility
    • Stone Mountain, GA
    • NPI 1184605693

    7810961380

    Same PAC ID

National Provider Directory

National Provider Directory
Tax ID family
Park Springs Home Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5610 New Bermuda Rd
Stone Mountain, GA 30087
Phone (678) 384-3872

500 Springhouse Cir
Stone Mtn, GA 30087
Phone (678) 684-3800

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500508800000",
    "number": "1962628669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SPRINGHOUSE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876718",
            "telephone_number": "770-879-4330",
            "fax_number": "678-684-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SPRINGHOUSE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876718",
            "telephone_number": "770-879-4330",
            "fax_number": "678-684-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK SPRINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2017-07-20",
        "status": "A",
        "authorized_official_last_name": "ISAKSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "404-932-6552"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK SPRINGS WELLNESS CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2017; 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.