NPIMap

Organization Active NPI

Physicians'S Professional Laboratory, P.C.

  • Specialist
  • Atlanta, GA
National Provider Identifier
1982774055
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
GA19749 Issued in GA
Legal business name
PHYSICIANS'S PROFESSIONAL LABORATORY, P.C.
Practice address
5665 Peachtree Dunwoody Rd NE
Atlanta, GA 30342-1701
Phone
(404) 252-1968
Fax
(404) 252-4609
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerry D Porter, MD
Title
Vice-President
Phone
(404) 252-1968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X GA19749 GA Primary

Addresses

Primary practice location

5665 Peachtree Dunwoody Rd NE
Atlanta, GA 30342-1701

Mailing address

PO Box 720298
Atlanta, GA 30358-2298
Phone (404) 252-1968

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412000001 GA Part B Supplier - Clinic/Group Practice 3173517489 Receives reassigned benefits from 9 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

5665 Peachtree Dunwoody
#R
Sandy Springs, GA 30342

Practitioners & affiliated clinicians

Practitioners 10

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982774055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720298",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303582298",
            "telephone_number": "404-252-1968",
            "fax_number": "404-252-4609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 PEACHTREE DUNWOODY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421701",
            "telephone_number": "404-252-1968",
            "fax_number": "404-252-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS'S PROFESSIONAL LABORATORY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "404-252-1968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "GA19749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.