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CENTERWELL SENIOR PRIMARY CARE-STONE MOUNTAIN
NPI 1760059331
Internal Medicine in Stone Mountain, GA

Active since June 10, 2021CLIA 11D2255911 · Waiver
5244 MEMORIAL DR STE 1101, STONE MOUNTAIN, GA 30083(404) 905-0100(877) 890-2406 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 3, 2024, Oct 14, 2022, Feb 14, 2022 and 2 more (5 updates tracked since 2021).

About Centerwell Senior Primary Care-stone Mountain NPPES

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

CENTERWELL SENIOR PRIMARY CARE-STONE MOUNTAIN (NPI 1760059331) is a healthcare organization registered as an internal medicine in Stone Mountain, Georgia and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through March 17, 2028 and lists Angie Martinez, Credentialing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1760059331
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE GA PC
Location Address5244 MEMORIAL DR STE 1101Stone Mountain, GA 30083-3157
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(404) 905-0100
Fax(877) 890-2406
Organization SubpartYes
Authorized OfficialAngie MartinezCredentialing Supervisor · (407) 447-7120
Enumeration DateJune 10, 2021
Last NPPES UpdateJuly 3, 20245 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1760059331 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
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.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedGeneral PracticeTaxonomy 208D00000X
5244 MEMORIAL DR STE 1101, Stone Mountain, GA 30083
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Other Names 1

Doing Business AsCenterwell Senior Primary Care-stone Mountain

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 11D2255911

Centerwell Senior Primary Care - Stone Mountain · Stone Mountain, GA
Active · expires Mar 17, 2028
CLIA Number11D2255911
Laboratory TypePhysician Office
Certificate Effective DateMarch 18, 2026
Certificate Expiration DateMarch 17, 2028
Laboratory DirectorErica Savage-Jeter
Laboratory Phone(404) 905-0100
Laboratory LocationCenterwell Senior Primary Care - Stone Mountain5244 Memorial Drive Suite #1101, Stone Mountain, GA 30083
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

THOMAS EYE GROUP PC
Optometrist
5244 MEMORIAL DR STE 1101
STONE MOUNTAIN, GA 30083
Dekalb County (678) 892-2020
TEMITOPE IBEREOLA AFON M.D.
Family Medicine
5244 MEMORIAL DR STE 1101
STONE MOUNTAIN, GA 30083
Dekalb County (404) 905-0100
MICHELLE SOOJUNG HONG
Nurse Practitioner
5244 MEMORIAL DR STE 1101
STONE MOUNTAIN, GA 30083
Dekalb County (404) 905-0100

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 Centerwell Senior Primary Care Ga PC's NPI number?

The NPI number for Centerwell Senior Primary Care Ga PC is 1760059331. It was assigned to this organization in the NPPES registry on June 10, 2021. The provider is doing business as Centerwell Senior Primary Care-Stone Mountain.

Where is Centerwell Senior Primary Care Ga PC located?

Centerwell Senior Primary Care Ga PC is located at 5244 Memorial Dr Ste 1101, Stone Mountain, GA 30083. The listed phone number is (404) 905-0100.

What is Centerwell Senior Primary Care Ga PC's specialty?

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

Does Centerwell Senior Primary Care Ga PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2255911) is associated with this NPI, valid through March 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care Ga PC was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.