MEDICARE: SANDY SPRINGS INTERNAL MEDICINE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	04359	GA

General Provider Information

NPI Number	:	1518949171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY SPRINGS INTERNAL MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	755 MOUNT VERNON HWY NE STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4280
Country	:	US
Telephone Number	:	678-222-3145
Fax Number	:	404-252-3720

Provider Business Practice Location Address
First Line	:	755 MOUNT VERNON HWY NE STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4280
Country	:	US
Telephone Number	:	678-222-3145
Fax Number	:	404-252-3720

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ARIEL ULLERY
Credential	:
Telephone Number	:	678-222-3142

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/21/2025

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