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PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC
NPI 1396033064
Internal Medicine in College Park, GA

Active since July 15, 2011
1631 PHOENIX BLVD STE 4, COLLEGE PARK, GA 30349(678) 788-8950(678) 788-8953 Get Directions Write a Review

NPPES record last updated: December 11, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Phoenix Medical Office At College Park,llc NPPES

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

PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC (NPI 1396033064) is a healthcare organization registered as an internal medicine in College Park, Georgia and active in the NPI registry since July 2011. The organization lists Kelvin Maurice Hamner, Owner/md, as its authorized official.

NPPES Registry Identity

NPI1396033064
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC
Location Address1631 PHOENIX BLVD STE 4College Park, GA 30349-5545
Mailing Address1631 Phoenix Blvd Ste 4College Park, GA 30349-5545 · (678) 788-8950 · Fax (678) 788-8953
Phone(678) 788-8950
Fax(678) 788-8953
Organization SubpartNo
Authorized OfficialKelvin Maurice HamnerOwner/md · (678) 788-8950
Enumeration DateJuly 15, 2011
Last NPPES UpdateDecember 11, 2012
✔ NPI 1396033064 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 · 39813
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.
1631 PHOENIX BLVD STE 4, College Park, GA 30349
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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 ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Phoenix Medical Office At College Park,llc 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 Phoenix Medical Office At College Park,llc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kelvin Hamner, M.D.
Internal Medicine
NPI 1073656344
1631 PHOENIX BLVD STE 4
College Park, GA 30349
(678) 788-8950
✔ PECOS✔ Accepts Medicare0.2 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 Phoenix Medical Office At College Park,llc's NPI number?

The NPI number for Phoenix Medical Office At College Park,llc is 1396033064. It was assigned to this organization in the NPPES registry on July 15, 2011.

Where is Phoenix Medical Office At College Park,llc located?

Phoenix Medical Office At College Park,llc is located at 1631 Phoenix Blvd Ste 4, College Park, GA 30349. The listed phone number is (678) 788-8950.

What is Phoenix Medical Office At College Park,llc's specialty?

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

Is Phoenix Medical Office At College Park,llc enrolled in Medicare?

Yes. Phoenix Medical Office At College Park,llc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Phoenix Medical Office At College Park,llc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Phoenix Medical Office At College Park,llc. 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.

What insurance does Phoenix Medical Office At College Park,llc accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Phoenix Medical Office At College Park,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 Phoenix Medical Office At College Park,llc was last updated on December 11, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.