Provider Demographics
NPI:1518949171
Name:SANDY SPRINGS INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:SANDY SPRINGS INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-222-3145
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4280
Mailing Address - Country:US
Mailing Address - Phone:678-222-3145
Mailing Address - Fax:404-252-3720
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4280
Practice Address - Country:US
Practice Address - Phone:678-222-3145
Practice Address - Fax:404-252-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1587Medicare PIN