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EAGLE MEDICAL CENTER
NPI 1073810453
General Practice in Roswell, GA

Active since February 19, 2011CLIA 11D2021413 · Waiver
804 BOMBAY LN, ROSWELL, GA 30076(770) 754-9880(770) 754-9881 Get Directions Write a Review

NPPES record last updated: February 19, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Eagle Medical Center NPPES

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

EAGLE MEDICAL CENTER (NPI 1073810453) is a healthcare organization registered as a general practice in Roswell, Georgia and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through March 13, 2027 and lists Kimberly Green, Physician, as its authorized official.

NPPES Registry Identity

NPI1073810453
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameGREENLINE MEDICAL CORPORATION
Location Address804 BOMBAY LNRoswell, GA 30076-5819
Mailing Address804 Bombay LnRoswell, GA 30076-5819
Phone(770) 754-9880
Fax(770) 754-9881
Organization SubpartNo
Authorized OfficialKimberly GreenPhysician · (770) 754-9880
Enumeration DateFebruary 19, 2011
✔ NPI 1073810453 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in GA · 058478
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPain Medicine · Pain MedicineTaxonomy 208VP0000X · License 058478 (GA)
804 BOMBAY LN, Roswell, GA 30076
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Other Names 1

Doing Business AsEagle Medical Center

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eagle Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Eagle Medical Center, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kimberly Green, D.O
General Practice
NPI 1720174873
1090 CAMBRIDGE SQ SUITE A
Alpharetta, GA 30009
(770) 754-9880
✔ PECOS1.6 mi

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

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 11D2021413

Greenline Medical Incorp, Dba Eagle Medical Ctr · Alpharetta, GA
Active · expires Mar 13, 2027
CLIA Number11D2021413
Laboratory TypePhysician Office
Certificate Effective DateMarch 14, 2025
Certificate Expiration DateMarch 13, 2027
Laboratory DirectorKimberly J. Green
Laboratory Phone(770) 754-9880
Laboratory LocationGreenline Medical Incorp, Dba Eagle Medical Ctr1090 Cambridge Square, Suite A Attn Katie, Alpharetta, GA 30009
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Greenline Medical Corporation's NPI number?

The NPI number for Greenline Medical Corporation is 1073810453. It was assigned to this organization in the NPPES registry on February 19, 2011. The provider is doing business as Eagle Medical Center.

Where is Greenline Medical Corporation located?

Greenline Medical Corporation is located at 804 Bombay Ln, Roswell, GA 30076. The listed phone number is (770) 754-9880.

What is Greenline Medical Corporation's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Greenline Medical Corporation enrolled in Medicare?

Yes. Greenline Medical Corporation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Greenline Medical Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Greenline Medical Corporation. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Greenline Medical Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2021413) is associated with this NPI, valid through March 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Greenline Medical Corporation was last updated on February 19, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.