NPIMap

Organization Active NPI

Northeast Internal Medicine, P.C.

  • Internal Medicine Physician
  • Monroe, GA
National Provider Identifier
1972636710
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
065514 Issued in GA
Legal business name
NORTHEAST INTERNAL MEDICINE, P.C.
Practice address
333 Alcovy St
Suite 8
Monroe, GA 30655-2180
Phone
(770) 267-9484
Fax
(770) 267-1600
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

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

Authorized official

Name
Dr. Marilyn Digamon-Beltran, MD
Title
President Ceo
Phone
(770) 267-9484

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 065514 GA Primary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0000X 027031 GA
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X 065514 GA

Addresses

Primary practice location

333 Alcovy St
Suite 8
Monroe, GA 30655-2180

Mailing address

333 Alcovy St
Suite 8
Monroe, GA 30655-2180
Phone (770) 267-9484

Other identifiers 8

IdentifierTypeStateIssuer
003124228AMedicaidGA
3692OtherGAGRP PTAN
027031OtherGALICENSE NUMBER
1639254881OtherGANPI
202I118301OtherGAPTAN
000299912AMedicaidGA
1912194960OtherGANPI
065514OtherGALICENSE NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1972636710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 ALCOVY ST",
            "address_2": "SUITE 8",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552180",
            "telephone_number": "770-267-9484",
            "fax_number": "770-267-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 ALCOVY ST",
            "address_2": "SUITE 8",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552180",
            "telephone_number": "770-267-9484",
            "fax_number": "770-267-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INTERNAL MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "DIGAMON-BELTRAN",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "770-267-9484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "065514",
            "primary": true
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "GA",
            "license": "027031",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "GA",
            "license": "065514",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124228A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP PTAN",
            "identifier": "3692",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "027031",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639254881",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "202I118301",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000299912A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1912194960",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "065514",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.