OrganizationActive
Advanced Internal Medicine
NPI 1669658829 · Primary Care Clinic/Center · Stockbridge, GA
Provider details
- NPI number
- 1669658829
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Faosat Odemuyiwa, Manager(770) 960-8855
- License
- 07-12143 (GA)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 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
235 Medical Blvd
Suite B
Stockbridge, GA 30281-7218
Phone: (770) 960-8855
Fax: (678) 565-1140
Street-level locationGet directions
Mailing address
Po Box 870116
Morrow, GA 30287-0116
Registry dates
- Enumerated
- 2008-01-17
- Last updated
- 2010-06-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.