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GEORGIA MEDICAL CLINIC
NPI 1124361811
Internal Medicine in Cumming, GA

Active since April 01, 2013CLIA 11D2209987 · Waiver
4415 FRONT NINE DR STE 600, CUMMING, GA 30041(770) 744-7688(770) 406-1058 Get Directions Write a Review

NPPES record last updated: February 14, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 14, 2023, Feb 11, 2023, Jul 27, 2022 and 1 more (4 updates tracked since 2022).

About Georgia Medical Clinic NPPES

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

GEORGIA MEDICAL CLINIC (NPI 1124361811) is a healthcare organization registered as an internal medicine in Cumming, Georgia and active in the NPI registry since April 2013. The organization holds a CLIA Waiver certificate valid through January 18, 2027 and lists Venkatappa Rangaraj, Owner, as its authorized official.

NPPES Registry Identity

NPI1124361811
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBLACKPOOL LLC
Location Address4415 FRONT NINE DR STE 600Cumming, GA 30041-6239
Mailing Address4415 Front Nine Dr Ste 600Cumming, GA 30041-6239 · (770) 744-7688 · Fax (770) 406-1058
Phone(770) 744-7688
Fax(770) 406-1058
Organization SubpartNo
Authorized OfficialVenkatappa RangarajOwner · (513) 218-3468
Enumeration DateApril 1, 2013
Last NPPES UpdateFebruary 14, 20234 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2023
✔ NPI 1124361811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in GA · 058633
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.
4415 FRONT NINE DR STE 600, Cumming, GA 30041
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Other Names 1

Doing Business AsGeorgia Medical Clinic

Other Identifiers 1

Medicaid003132617AGA

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

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 ›

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 11D2209987

Georgia Medical Clinic · Cumming, GA
Active · expires Jan 18, 2027
CLIA Number11D2209987
Laboratory TypePhysician Office
Certificate Effective DateJanuary 19, 2025
Certificate Expiration DateJanuary 18, 2027
Laboratory DirectorVenkat Rangaraj
Laboratory Phone(678) 825-5614
Laboratory LocationGeorgia Medical Clinic4415 Front Nine Drive Suite #699, Cumming, GA 30014
CLIA data matches this NPI record on: Name
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.

DR. VENKATAPPA RANGARAJ M.D.
Internal Medicine
4415 FRONT NINE DR STE 600
CUMMING, GA 30041
Forsyth County (770) 744-7688
NIRALI PATEL NP
Nurse Practitioner
4415 FRONT NINE DR STE 600
CUMMING, GA 30041
Forsyth County (678) 456-8463

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 Blackpool LLC's NPI number?

The NPI number for Blackpool LLC is 1124361811. It was assigned to this organization in the NPPES registry on April 1, 2013. The provider is doing business as Georgia Medical Clinic.

Where is Blackpool LLC located?

Blackpool LLC is located at 4415 Front Nine Dr Ste 600, Cumming, GA 30041. The listed phone number is (770) 744-7688.

What is Blackpool LLC's specialty?

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

Does Blackpool LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2209987) is associated with this NPI, valid through January 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Blackpool LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Blackpool 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 Blackpool LLC was last updated on February 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.