COMMUNITY PRIMARY CARE OF GEORGIA LLC (NPI# 1336492511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336492511 |
| Entity Type | Organization |
| Organization Name | COMMUNITY PRIMARY CARE OF GEORGIA LLC |
| Practice Address |
1005 Boulder Dr Gray GA 31032-6141 |
| Practice Telephone | 4786212100 |
| Practice Fax Number | 4787440481 |
| Mailing Telephone | 4786212100 |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2019-06-28 |
| Authorized Official Name | ELIZE JOSEPH (DIRECTOR OF PRACTICE MANAGEMENT) |
| Authorized Official Telephone | 4786212100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4421 Carnes St, Acworth, GA 301015305 | 4786212072 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053662296 | Community Primary Care of Georgia LLC | Family Medicine | 946 Veterans Pkwy, Barnesville, GA 30204-3771 | 2012-09-27 |
| 1861744179 | Community Primary Care of Georgia LLC | Family Medicine | 343 Plantation Way, Macon, GA 31210-9286 | 2012-10-10 |
| 1730430968 | Community Primary Care of Georgia LLC | Family Medicine | 165 S Broad St, Butler, GA 31006-5526 | 2012-09-27 |
| 1447501689 | Community Primary Care of Georgia LLC | Family Medicine | 529 Bolingreen Dr, Macon, GA 31210-5303 | 2012-09-27 |
| Street Address |
1005 BOULDER DR |
| City | GRAY |
| State | GA |
| Zip Code | 31032-6141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548263064 | Wyatt Kenny Blake | Family Medicine | 1005 Boulder Dr, Gray, GA 31032 | 2005-05-30 |
| 1134781073 | Michael Kelly | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2019-07-01 |
| 1356807507 | Sarah Rose Purser | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2019-02-13 |
| 1548760556 | Brianna Carolyn Jo Ramseur | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2018-02-16 |
| 1932650173 | Shannon Dawn Coffee | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2016-10-24 |
| 1720475098 | N'kema Cooper | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2015-04-23 |
| 1740629443 | Betty Lou Yul Riner | Clinical Nurse Specialist | 1005 Boulder Dr, Gray, GA 31032 | 2013-06-17 |
| 1235574906 | Heather Lewis | Physician Assistant | 1005 Boulder Dr, Gray, GA 31032 | 2013-05-07 |
| 1245584788 | Catherine Marie Wilson | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2012-11-06 |
| 1538416821 | Shawn Marie Watts | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2012-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225669120 | True Essential Service, LLC | Home Health | 112 Madison Avenue, Gray, GA 31032 | 2020-01-29 |
| 1740640234 | Tuquester L. Carlisle | Marriage & Family Therapist | 300 West Clinton St., Suite I, Gray, GA 31032 | 2016-02-26 |
| 1821404161 | Linda Norman Greene | Home Health Aide | 3562 Gray Highway, Gray, GA 31032 | 2014-07-08 |
| 1770876781 | Gray Dental Associates, P.C. | Dentist | 242 West Clinton St, Gray, GA 31032 | 2011-05-24 |
| 1245404516 | Louise E Simmons | Nurse's Aide | 426 Liberty Street, Gray, GA 31032 | 2008-04-17 |
| 1396929568 | Albert H Mcgalliard | Pharmacist | 236 West Clinton St, Gray, GA 31032 | 2007-12-24 |
| 1184845067 | Todd F Kelleher | Chiropractor | 4292 Gray Highway, Gray, GA 31032 | 2007-05-01 |
| 1477690014 | S & S Medical Management Services, Inc | Durable Medical Equipment & Medical Supplies | 221 West Clinton Street, Suite F, Gray, GA 31032 | 2007-01-31 |
| 1235290859 | River Edge Behavorial Health Center | Community/Behavioral Health | 324 Highway 18 East, Gray, GA 31032 | 2006-12-13 |
| 1437211067 | River Edge Behavioral Health Center | Community/Behavioral Health | 502 West Clinton Street, Gray, GA 31032 | 2006-12-13 |
| Find all providers in zip 31032 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295366292 | B Mata LLC | Family Medicine | 1631 Atlanta Hwy, Gainesville, GA 30504-5942 | 2020-01-28 |
| 1558916056 | Newtown Park Medical Clinic and Geriatrics LLC | Family Medicine | 2880 Old Alabama Rd #300, Johns Creek, GA 30022-5033 | 2019-08-02 |
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1275002636 | Patriot Healthcare of Georgia, LLC | Family Medicine | 1587 Phoenix Boulevard, Suite 6, College Park, GA 30349 | 2018-11-15 |
| 1215471479 | Deana Perkins | Family Medicine | 756 Arrowhead Lake Rd, Thomaston, GA 30286-5004 | 2016-12-07 |
| 1255731741 | Jafar Tabatabai M.d. P.C. | Family Medicine | 7961 Highway 92 Ste 100, Woodstock, GA 30189-5209 | 2014-09-03 |
| 1457604381 | Senior Care Plus Limited Liability Company | Family Medicine | 990 Peachtree Industrial Blvd Number 4532, Suwanee, GA 30024-5249 | 2012-10-16 |
| 1053662296 | Community Primary Care of Georgia LLC | Family Medicine | 946 Veterans Pkwy, Barnesville, GA 30204-3771 | 2012-09-27 |
| 1669770954 | J&a Wood, LLC | Family Medicine | 2724 Grey Fox Ct, Haddock, GA 31033-6009 | 2011-03-10 |
| 1043442080 | Sam Peng Md PC | Family Medicine | 1622 Rivergreen Bnd Se, Atlanta, GA 30339-8546 | 2009-08-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.