Centerwell Senior Primary Care Ga PC
Internal Medicine in Stone Mountain, GA. Organization (NPI-2).
NPI number1760059331
StatusActive
Last updated in NPPESAug 24, 2026
Details
- NPI
- 1760059331
- Entity type
- Organization (NPI-2)
- Legal business name
- Centerwell Senior Primary Care Ga PC
- Organization subpart
- Yes
- Enumeration date
- Jun 10, 2021
- Certification date
- Aug 24, 2026
- Last updated
- Aug 24, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 208D00000X | General Practice | – | – |
Other names
- Centerwell Senior Primary Care-Stone Mountain (Doing Business As)
Practice location
5244 Memorial DriveSuite 1101
Stone Mountain, GA 30083-3157
Phone 404-905-0100 · Fax 877-890-2406
Mailing address
6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168
Phone 305-500-2000
Authorized official
Angie Martinez
Credentialing Supervisor
4074477120
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