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PROVIDENCE RD PRIMARY CARE LLC
NPI 1831537539
Internal Medicine in Marietta, GA

Active since June 05, 2013CLIA 11D2144488 · Waiver
4180 PROVIDENCE RD, STE 105, MARIETTA, GA 30062(770) 973-4749(770) 973-4349 Get Directions Write a Review

NPPES record last updated: June 5, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Providence Rd Primary Care Llc NPPES

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

PROVIDENCE RD PRIMARY CARE LLC (NPI 1831537539) is a healthcare organization registered as an internal medicine in Marietta, Georgia and active in the NPI registry since June 2013. The organization holds a CLIA Waiver certificate valid through February 18, 2028 and lists Amma Abunyewa, Provider, as its authorized official.

NPPES Registry Identity

NPI1831537539
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePROVIDENCE RD PRIMARY CARE LLC
Location Address4180 PROVIDENCE RD, STE 105Marietta, GA 30062-6186
Mailing Address4180 Providence Rd, Ste 105Marietta, GA 30062-6186 · (770) 973-4749 · Fax (770) 973-4349
Phone(770) 973-4749
Fax(770) 973-4349
Organization SubpartNo
Authorized OfficialAmma AbunyewaProvider · (770) 973-4749
Enumeration DateJune 5, 2013
✔ NPI 1831537539 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 · 64774
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.
4180 PROVIDENCE RD, Marietta, GA 30062
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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Rd Primary Care 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 Providence Rd Primary Care LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Amma Abunyewa, M.D.
Internal Medicine
NPI 1982932745
4180 PROVIDENCE RD STE 105
Marietta, GA 30062
(770) 973-4749
✔ PECOS✔ Accepts MedicareSame address

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 11D2144488

Providence Rd Primary Care · Marietta, GA
Active · expires Feb 18, 2028
CLIA Number11D2144488
Laboratory TypePhysician Office
Certificate Effective DateFebruary 19, 2026
Certificate Expiration DateFebruary 18, 2028
Laboratory DirectorAmma Abunyewa
Laboratory Phone(770) 973-4749
Laboratory LocationProvidence Rd Primary Care4180 Providence Rd, Suite 105, Marietta, GA 30062
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Providence Rd Primary Care LLC's NPI number?

The NPI number for Providence Rd Primary Care LLC is 1831537539. It was assigned to this organization in the NPPES registry on June 5, 2013.

Where is Providence Rd Primary Care LLC located?

Providence Rd Primary Care LLC is located at 4180 Providence Rd Ste 105, Marietta, GA 30062. The listed phone number is (770) 973-4749.

What is Providence Rd Primary Care LLC's specialty?

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

Is Providence Rd Primary Care LLC enrolled in Medicare?

Yes. Providence Rd Primary Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Rd Primary Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Providence Rd Primary Care 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.

Does Providence Rd Primary Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2144488) is associated with this NPI, valid through February 18, 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 Providence Rd Primary Care LLC was last updated on June 5, 2013. 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.