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NPI 1124889514 · Emergency Medicine Physician · Atlanta, GA
Provider details
- NPI number
- 1124889514
- Entity type
- Organization
- Primary specialty
- Emergency Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kim Larsen, Director of Credentialing(770) 874-5400
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
- Hospitalist Physician208M00000X
Allopathic & Osteopathic Physicians
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
- Nurse Practitioner363L00000X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2024-01-22
- Last updated
- 2024-01-22
- Certified
- 2024-01-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.