Provider Demographics
NPI:1780280776
Name:CERIUM FAMILY PRACTICE AND URGENT MEDICINE, LLC
Entity type:Organization
Organization Name:CERIUM FAMILY PRACTICE AND URGENT MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SONDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-296-8100
Mailing Address - Street 1:2799 LAWRENCEVILLE HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2517
Mailing Address - Country:US
Mailing Address - Phone:042-968-1004
Mailing Address - Fax:770-741-0948
Practice Address - Street 1:2799 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:404-297-3440
Practice Address - Fax:770-741-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care