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CLARKSTON PRIMARY & URGENT CARE, LLC
NPI 1043781420
Family Medicine in Clarkston, GA

Active since December 11, 2018
4600 E PONCE DE LEON AVE STE A, CLARKSTON, GA 30021(770) 703-5408(877) 779-5837 Get Directions Write a Review

NPPES record last updated: December 11, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Clarkston Primary & Urgent Care, Llc NPPES

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

CLARKSTON PRIMARY & URGENT CARE, LLC (NPI 1043781420), doing business as Clarkston Primary & Urgent Care Llc, is a healthcare organization registered as a family medicine in Clarkston, Georgia and active in the NPI registry since December 2018. The organization lists Etsubdenke Areaya, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1043781420
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCLARKSTON PRIMARY & URGENT CARE, LLC
Location Address4600 E PONCE DE LEON AVE STE AClarkston, GA 30021-1839
Mailing Address4600 E Ponce De Leon Ave Ste AClarkston, GA 30021-1839 · (770) 703-5408 · Fax (877) 779-5837
Phone(770) 703-5408
Fax(877) 779-5837
Organization SubpartNo
Authorized OfficialEtsubdenke AreayaAuthorized Official · (678) 763-2247
Enumeration DateDecember 11, 2018
✔ NPI 1043781420 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4600 E PONCE DE LEON AVE STE A, Clarkston, GA 30021
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Other Names 1

Doing Business AsClarkston Primary & Urgent Care Llc

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 MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Clarkston Primary & Urgent Care, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Clarkston Primary & Urgent Care, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Lilian Vende
Nurse Practitioner
NPI 1225886609
4600 E PONCE DE LEON AVE STE A
Clarkston, GA 30021
(678) 705-9685
✔ PECOSSame address
Fariba Sohrabi, DNP
Nurse Practitioner
NPI 1871427641
4600 E PONCE DE LEON AVE STE A
Clarkston, GA 30021
(801) 200-2872
✔ PECOSSame address
Mandana Rezaei Amiri, M.D.
Internal Medicine
NPI 1518923879
1686 ROSWELL RD
Marietta, GA 30062
(770) 933-9333
✔ PECOS✔ Accepts Medicare18 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Clarkston Primary & Urgent Care, LLC's NPI number?

The NPI number for Clarkston Primary & Urgent Care, LLC is 1043781420. It was assigned to this organization in the NPPES registry on December 11, 2018. The provider is doing business as Clarkston Primary & Urgent Care LLC.

Where is Clarkston Primary & Urgent Care, LLC located?

Clarkston Primary & Urgent Care, LLC is located at 4600 E Ponce De Leon Ave Ste A, Clarkston, GA 30021. The listed phone number is (770) 703-5408.

What is Clarkston Primary & Urgent Care, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Clarkston Primary & Urgent Care, LLC enrolled in Medicare?

Yes. Clarkston Primary & Urgent Care, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Clarkston Primary & Urgent Care, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Clarkston Primary & Urgent Care, LLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Clarkston Primary & Urgent Care, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Clarkston Primary & Urgent Care, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Clarkston Primary & Urgent Care, LLC was last updated on December 11, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.