Provider Demographics
NPI:1972792265
Name:PERIMETER MEDICAL ASSOCIATES,P.C.
Entity type:Organization
Organization Name:PERIMETER MEDICAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRATICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:POYTHRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-446-1340
Mailing Address - Street 1:3775 N DRUID HILLS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3729
Mailing Address - Country:US
Mailing Address - Phone:404-446-1340
Mailing Address - Fax:404-446-3497
Practice Address - Street 1:3775 N. DRUID HILLS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-446-1340
Practice Address - Fax:404-446-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041922207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA99335Medicare UPIN