SOUTH ATLANTA INTEGRATIVE MEDICINE
NPI 1760848980
Family Medicine in Fayetteville, GA
About South Atlanta Integrative Medicine NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH ATLANTA INTEGRATIVE MEDICINE (NPI 1760848980) is a healthcare organization registered as a family medicine in Fayetteville, Georgia and active in the NPI registry since January 2016. The organization holds a CLIA Waiver certificate valid through April 26, 2028 and lists Lynn Stanley, Authorized Official, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
South Atlanta Integrative Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to South Atlanta Integrative Medicine, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Fayetteville, GA 30214
Fayetteville, GA 30214
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 11D2112333
South Atlanta Intergrative Medicine, LLC · Fayetteville, GAFrequently 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 South Atlanta Integrative Medicine's NPI number?
The NPI number for South Atlanta Integrative Medicine is 1760848980. It was assigned to this organization in the NPPES registry on January 4, 2016.
Where is South Atlanta Integrative Medicine located?
South Atlanta Integrative Medicine is located at 1240 Highway 54 W Building 700, Suite 700, Fayetteville, GA 30214. The listed phone number is (404) 452-9931.
What is South Atlanta Integrative Medicine's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is South Atlanta Integrative Medicine enrolled in Medicare?
Yes. South Atlanta Integrative Medicine is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through South Atlanta Integrative Medicine?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to South Atlanta Integrative Medicine, in Family Practice and Nurse Practitioner. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does South Atlanta Integrative Medicine hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2112333) is associated with this NPI, valid through April 26, 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 South Atlanta Integrative Medicine was last updated on January 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# South Atlanta Integrative Medicine · NPI 1760848980
Family Medicine organization in Fayetteville, Georgia. Organization record, active in the CMS NPPES registry since January 4, 2016.
## Identity
- **NPI:** 1760848980 (Entity type: Organization)
- **Enumerated:** January 4, 2016
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Lynn Stanley, AUTHORIZED OFFICIAL
## Practice location
- **Address:** 1240 HIGHWAY 54 W, BUILDING 700, SUITE 700, Fayetteville, GA 30214-4557
- **Phone:** (404) 452-9931
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 4, 2016
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1760848980) · Data from the CMS NPPES public registry.