SPORTS MEDICINE SOUTH OF GWINNETT LLC - NPI 1265053110 - Orthopaedic Surgery in Lawrenceville, GA

Q: What is the provider's specialty?

The provider's specialty is Orthopaedic Surgery with taxonomy code 207XX0005X and a focus in Sports Medicine.

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About Sports Medicine South Of Gwinnett Llc NPPES

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

SPORTS MEDICINE SOUTH OF GWINNETT LLC (NPI 1265053110) is a healthcare organization registered as a sports medicine in Lawrenceville, Georgia and active in the NPI registry since May 2020. The organization holds a CLIA Waiver certificate valid through June 22, 2028 and lists Amy E Fouts, Chief Compliance Officer, as its authorized official.

NPPES Registry Identity

NPI1265053110

Entity TypeOrganization

Primary Taxonomy207XX0005X

Legal Business NameSPORTS MEDICINE SOUTH OF GWINNETT LLC

Location Address1900 RIVERSIDE PKWYLawrenceville, GA 30043-5925

Mailing Address1001 Summit Blvd Ste 1000Brookhaven, GA 30319-6415 · (404) 851-8000

Phone(770) 237-3475

Organization SubpartNo

Authorized OfficialAmy E FoutsChief Compliance Officer · (404) 851-6968

Enumeration DateMay 1, 2020

Last NPPES UpdateMay 18, 20264 updates tracked since enumeration

NPPES CertifiedMay 18, 2026

✔ NPI 1265053110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207XX0005X

Definition

An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.

1900 RIVERSIDE PKWY, Lawrenceville, GA 30043

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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

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 11D1085597

Sports Medicine South LLC · Lawrenceville, GA

Active · expires Jun 22, 2028

CLIA Number11D1085597

Laboratory TypePhysician Office

Certificate Effective DateJune 23, 2026

Certificate Expiration DateJune 22, 2028

Laboratory DirectorGary A. Levengood MD

Laboratory Phone(770) 237-3475

Laboratory LocationSports Medicine South LLC1900 Riverside Parkway, Lawrenceville, GA 30043

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 13

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

GARY A LEVENGOOD M.D.

Orthopaedic Surgery