PHYSICIAN MANAGEMENT SERVICES OF EASTERN GEORGIA, LLC (NPI# 1780125294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780125294 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN MANAGEMENT SERVICES OF EASTERN GEORGIA, LLC |
| Practice Address |
410 Peachtree Pkwy Suite 4260 Cumming GA 30041-7066 |
| Mailing Address |
3113 Lawton Rd Suite 250 Orlando FL 32803-3531 |
| Practice Telephone | 8888298550 |
| Mailing Telephone | 8888298550 |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |
| Authorized Official Name | BRETT KENEFICK (PRESIDENT) |
| Authorized Official Telephone | 8888298550 |
| Is Organization Subpart | Y |
| Parent Organization Name | VAXCARE CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 049380 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE PTAN | PHC059 | 01 |
| Street Address |
410 PEACHTREE PKWY SUITE 4260 |
| City | CUMMING |
| State | GA |
| Zip Code | 30041-7066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235105032 | Diane Green King | Specialist/Technologist | 410 Peachtree Pkwy, Suite 300, Cumming, GA 30041-7066 | 2006-02-23 |
| 1437516770 | Live Life Counseling, LLC | Counselor | 410 Peachtree Pkwy, Suite 4245, Cumming, GA 30041-7066 | 2016-01-18 |
| 1366807489 | Pathways To Change, LLC | Exclusive Provider Organization | 410 Peachtree Pkwy, Building 400, Suite 4245, Cumming, GA 30041-7066 | 2015-12-16 |
| 1033549027 | Inner Journeys Counseling Services LLC | Counselor | 410 Peachtree Pkwy, Bldg 400, Suite 4245, Cumming, GA 30041-7066 | 2013-11-12 |
| 1437584810 | Pam Mcghee Gibbs | Counselor | 410 Peachtree Pkwy, Bldg 400, Suite 4245, Cumming, GA 30041-7066 | 2013-09-04 |
| 1235498726 | Kristin Kay Leblanc | Counselor | 410 Peachtree Pkwy, Suite 4245, Cumming, GA 30041-7066 | 2012-05-03 |
| 1932475779 | Brian Lee Long | Counselor | 410 Peachtree Pkwy, 4245, Cumming, GA 30041-7066 | 2012-03-27 |
| 1285932814 | Scottish Rite Children's Medical Center | Prosthetic/Orthotic Supplier | 410 Peachtree Pkwy, Suite 300, Cumming, GA 30041-7066 | 2011-03-07 |
| 1285810325 | Michael James Crosby | Dentist | 410 Peachtree Pkwy, Cumming, GA 30041-7066 | 2008-01-19 |
| 1972706893 | Sleep Health Diagnostics, LLC. | Clinic/Center | 410 Peachtree Pkwy, Suite 4232, Cumming, GA 30041-7066 | 2007-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962036905 | Annie Kyungjin Han | Nurse Practitioner | 1505 Northside Forsyth Drive, Suite 2500, Cumming, GA 30041 | 2020-02-28 |
| 1295388197 | Pamela Edler | Pharmacist | 1200 Northside Forsyth Drive, Pharmacy Department, Cumming, GA 30041 | 2019-07-19 |
| 1720557127 | Dr. Tiffany Lamonde LLC | Physical Therapist | 1445 Haw Creek Circle, Suite 503, Cumming, GA 30041 | 2018-11-15 |
| 1487140893 | Bhbd LLC | Chiropractor | 425 Peachtree Parkway, Suite 315, Cumming, GA 30041 | 2018-07-09 |
| 1891219861 | Anna Gawrys | Pharmacist | 1525 Marketplace Blvd, Cumming, GA 30041 | 2017-08-01 |
| 1679029219 | Square One Dental LLC | Clinic/Center | 3510 Rowe Lane, Cumming, GA 30041 | 2016-09-01 |
| 1720441454 | Pavilion Psychological Services LLC | Psychologist | 1445 Haw Creek Corners Circle East, Suite 501, Cumming, GA 30041 | 2016-03-31 |
| 1346606506 | American Health Imaging of Ga, LLC | Clinic/Center | 1050 Haw Creek Pkwy, Suite 100, Cumming, GA 30041 | 2016-01-04 |
| 1013311307 | Stephen Hartle | Physician Assistant | 2576 Peachtree Pkwy, Suite 100, Cumming, GA 30041 | 2014-10-15 |
| 1063828408 | Stephanie Evans Wellborn | Physician Assistant | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041 | 2014-07-07 |
| Find all providers in zip 30041 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, 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 Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811473366 | Anytime Physicians LLC | Family Medicine | 3482 Keith Bridge Rd Ste 131, Cumming, GA 30041-5546 | 2018-07-18 |
| 1023368693 | Family Medicine and Urgent Care, P.C. | Family Medicine | 4415 Front Nine Drive, Suite 700, Cumming, GA 30041-6018 | 2012-09-11 |
| 1033401302 | Rishita Patel | Family Medicine | 2825 Keith Bridge Rd Ste 100, Cumming, GA 30041 | 2011-05-05 |
| 1861647208 | Nandana R Reddy | Family Medicine | 2655 Hermitage Dr, Cumming, GA 30041-6337 | 2008-11-26 |
| 1235309469 | Jayasri Mallavarapu | Family Medicine | 1614 Peachtree Pkwy, Suite 200, Cumming, GA 30041-6883 | 2008-03-04 |
| 1093877961 | Jacob Varghese | Family Medicine | 1400 Northside Forsyth Office, Suite 350, Cumming, GA 30041 | 2006-12-15 |
| 1992805006 | Nibedita Patro | Family Medicine | 1080 Sanders Rd, Ste 100, Cumming, GA 30041-8057 | 2006-09-25 |
| 1710084793 | Lea A Danielsen | Family Medicine | 5435 Oakrun Cir, Cumming, GA 30040-1211 | 2006-09-20 |
| 1497857841 | David Arnel Ragan | Family Medicine | 610 Peachtree Parkway, Suite 201, Cumming, GA 30041-9712 | 2006-09-05 |
| 1710096227 | Annmarie Stokes | Family Medicine | 634 Peachtree Pkwy, Suite 282, Cumming, GA 30041-9782 | 2006-08-29 |
| Find all providers in CUMMING | ||||
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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.