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SOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC
NPI 1952599516
Family Medicine in Alpharetta, GA

Active since October 09, 2007CLIA 11D1031100 · Microscopy
1845 LOCKEWAY DR, SUITE 404, ALPHARETTA, GA 30004(770) 343-9112(770) 343-8911 Get Directions Write a Review

NPPES record last updated: January 17, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About South Forsyth Family Medicine And Pediatrics Llc NPPES

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

SOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC (NPI 1952599516) is a healthcare organization registered as a family medicine in Alpharetta, Georgia and active in the NPI registry since October 2007. The organization holds a CLIA Microscopy certificate valid through September 22, 2028 and lists Dina J Gore, Medical Billing & Insurance Manager, as its authorized official.

NPPES Registry Identity

NPI1952599516
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC
Location Address1845 LOCKEWAY DR, SUITE 404Alpharetta, GA 30004-5936
Mailing Address1845 Lockeway Dr, Suite 404Alpharetta, GA 30004-5936 · (770) 343-9112 · Fax (770) 343-8911
Phone(770) 343-9112
Fax(770) 343-8911
Organization SubpartNo
Authorized OfficialDina J GoreMedical Billing & Insurance Manager · (770) 343-9112
Enumeration DateOctober 9, 2007
Last NPPES UpdateJanuary 17, 2013
✔ NPI 1952599516 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in GA · 2401782
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedPediatricsTaxonomy 208000000X · License 2401782 (GA)
1845 LOCKEWAY DR, Alpharetta, GA 30004
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Other Identifiers 3

Medicare PINGRP6888GA
Medicaid000630759EGA
Medicaid000630759FGA

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health 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)

South Forsyth Family Medicine And Pediatrics Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to South Forsyth Family Medicine And Pediatrics LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

David Boaz, M.D.
Family Practice
NPI 1750305124
1845 LOCKEWAY DR SUITE 404
Alpharetta, GA 30004
(770) 343-9112
✔ PECOSSame address
Mark Glodener, MD
Family Practice
NPI 1174629885
1845 LOCKEWAY DR SUITE 404
Alpharetta, GA 30004
(770) 343-9112
✔ PECOSSame 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 for Provider-Performed Microscopy Procedures (PPMP) 11D1031100

South Forsyth Family Medicine And Pediatrics · Alpharetta, GA
Active · expires Sep 22, 2028
CLIA Number11D1031100
Laboratory TypePhysician Office
Certificate Effective DateSeptember 23, 2026
Certificate Expiration DateSeptember 22, 2028
Laboratory DirectorMark Glodener
Laboratory Phone(770) 343-9112
Laboratory LocationSouth Forsyth Family Medicine And Pediatrics1845 Lockeway Drive Suite 404, Alpharetta, GA 30004
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform 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 South Forsyth Family Medicine And Pediatrics LLC's NPI number?

The NPI number for South Forsyth Family Medicine And Pediatrics LLC is 1952599516. It was assigned to this organization in the NPPES registry on October 9, 2007.

Where is South Forsyth Family Medicine And Pediatrics LLC located?

South Forsyth Family Medicine And Pediatrics LLC is located at 1845 Lockeway Dr Suite 404, Alpharetta, GA 30004. The listed phone number is (770) 343-9112.

What is South Forsyth Family Medicine And Pediatrics LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is South Forsyth Family Medicine And Pediatrics LLC enrolled in Medicare?

Yes. South Forsyth Family Medicine And Pediatrics LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through South Forsyth Family Medicine And Pediatrics LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to South Forsyth Family Medicine And Pediatrics 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does South Forsyth Family Medicine And Pediatrics LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 11D1031100) is associated with this NPI, valid through September 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does South Forsyth Family Medicine And Pediatrics LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list South Forsyth Family Medicine And Pediatrics 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 South Forsyth Family Medicine And Pediatrics LLC was last updated on January 17, 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.