=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295936318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERIMETER NORTH FAMILY PRACTICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 JOHNSON FERRY RD NE SUITE 300
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-255-7325
-----------------------------------------------------
Fax | 404-255-3055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 DUNWOODY PARK SUITE 129
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-6796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-395-0919
-----------------------------------------------------
Fax | 770-395-9950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO CEO
-----------------------------------------------------
Name | DR. THOMAS J HIGH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-255-7325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------