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1043981517 NPI number — ESTATE CLINICS BY CMG

NPI Number: 1043981517
Health Care Provider/Practitioner: ESTATE CLINICS BY CMG

Information about “1043981517” NPI (ESTATE CLINICS BY CMG) exists in 1043981517 in HTML format HTML  |  1043981517 in plain Text format TXT  |  1043981517 in PDF (Portable Document Format) PDF  |  1043981517 in an XML format XML  formats.

NPI Number : 1043981517 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043981517",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ESTATE CLINICS BY CMG",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "483 UPPER RIVERDALE RD SW STE F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERDALE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30274-2579",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-742-3883",
    "MailingAddressFaxNumber": "855-597-8504",
    "FirstLinePracticeLocationAddress": "107 UPPER RIVERDALE RD SW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERDALE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30274-2504",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-997-2160",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2021",
    "LastUpdateDate": "09/24/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTIN",
    "AuthorizedOfficialFirstName": "KAYLENE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "770-990-8212",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR1100X",
          "TaxonomyName": "Research Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QU0200X",
          "TaxonomyName": "Urgent Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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