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EPITOME PRIMARY CARE
NPI 1023835782
Internal Medicine in Marietta, GA

Active since September 24, 2024CLIA 11D2310659 · Waiver
631 CAMPBELL HILL ST NW STE 200, MARIETTA, GA 30060(770) 727-6124 Get Directions Write a Review

NPPES record last updated: December 4, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 4, 2024, Sep 24, 2024 (2 updates tracked since 2024).

About Epitome Primary Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EPITOME PRIMARY CARE (NPI 1023835782) is a healthcare organization registered as an internal medicine in Marietta, Georgia and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through September 7, 2026 and lists Kenette St-gourdin, Owner, as its authorized official.

NPPES Registry Identity

NPI1023835782
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameEPITOME PRIMARY CARE
Location Address631 CAMPBELL HILL ST NW STE 200Marietta, GA 30060-1390
Mailing Address631 Campbell Hill St Nw Ste 200Marietta, GA 30060-1390 · (770) 727-6124
Phone(770) 727-6124
Organization SubpartNo
Authorized OfficialKenette St-gourdinOwner · (912) 695-6080
Enumeration DateSeptember 24, 2024
Last NPPES UpdateDecember 4, 20242 updates tracked since enumeration
NPPES CertifiedDecember 4, 2024
✔ NPI 1023835782 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
631 CAMPBELL HILL ST NW STE 200, Marietta, GA 30060
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2310659

Epitome Primary Care · Marietta, GA
Active · expires Sep 7, 2026
CLIA Number11D2310659
Laboratory TypePhysician Office
Certificate Effective DateSeptember 8, 2024
Certificate Expiration DateSeptember 7, 2026
Laboratory DirectorKennette St-Gourdin
Laboratory Phone(770) 727-6124
Laboratory LocationEpitome Primary Care631 Campbell Hill Street, NW, Suite 200, Marietta, GA 30060
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENETTE ST-GOURDIN MD
Internal Medicine
631 CAMPBELL HILL ST NW STE 200
MARIETTA, GA 30060
Cobb County (770) 727-4130
WINDSOR PAMPHILE MD
Internal Medicine
631 CAMPBELL HILL ST NW STE 200
MARIETTA, GA 30060
Cobb County (912) 695-6090

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Epitome Primary Care's NPI number?

The NPI number for Epitome Primary Care is 1023835782. It was assigned to this organization in the NPPES registry on September 24, 2024.

Where is Epitome Primary Care located?

Epitome Primary Care is located at 631 Campbell Hill St NW Ste 200, Marietta, GA 30060. The listed phone number is (770) 727-6124.

What is Epitome Primary Care's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Epitome Primary Care hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2310659) is associated with this NPI, valid through September 7, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Epitome Primary Care was last updated on December 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.