OrganizationActive
Centerwell Senior Primary Care Ga PC
NPI 1760059331 · Internal Medicine Physician · Stone Mountain, GA
Provider details
- NPI number
- 1760059331
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Centerwell Senior Primary Care Ga PC
- Organization subpart
- Yes
- Authorized official
- Angie Martinez, Credentialing Supervisor(407) 447-7120
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- General Practice Physician208D00000X
Allopathic & Osteopathic Physicians
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 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
5244 Memorial Dr Ste 1101
Stone Mountain, GA 30083-3157
Phone: (404) 905-0100
Fax: (877) 890-2406
Street-level locationGet directions
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Other names (DBA / former)
- Doing business as
- Centerwell Senior Primary Care-Stone Mountain
- Doing business as
- Centerwell Senior Primary Care-Stone Mountain
Registry dates
- Enumerated
- 2021-06-10
- Last updated
- 2024-07-03
- Certified
- 2024-07-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.