Derek Paul Pendarvis (NPI# 1104806108, PAC ID# 2466578935) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1104806108 |
| PAC ID by PECOS | 2466578935 |
| Professional Enrollment ID | I20100922000642 |
| Full Name | Derek Paul Pendarvis |
| Organization Legal Name | THE LONGSTREET CLINIC, PC |
| Address |
725 Jesse Jewell Pkwy Suite 150 Gainesvilel GA 30501-3834 |
| Phone Number | 7702975700 |
| Gender | M |
| Medical School | MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE |
| Graduation Year | 1996 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 2668465733 |
| Number of Group Practice Members | 114 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110029 | NORTHEAST GEORGIA MEDICAL CENTER, INC |
| Address | Phone | Organization |
|---|---|---|
| 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 | 7702975700 | THE LONGSTREET CLINIC, PC |
| 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 7707181122 | THE LONGSTREET CLINIC, PC |
| 725 Jesse Jewell Sepkwy, Suite 100, Gainesville, GA 30501-3836 | 7705353611 | THE LONGSTREET CLINIC, PC |
| Organization Legal Name | THE LONGSTREET CLINIC, PC |
| Physicians | 137 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Evgenia Korytnaya | Endocrinology | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 |
| Hugh Colby Cornelson | Nurse Practitioner | The Longstreet Clinic, PC | 655 Jesse Jewell Pkwy Se, Suite A, Gainesville, GA 30501-3854 |
| Erica Mcdaniel Abney | Physician Assistant | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Karl D Schultz | Neurosurgery | The Longstreet Clinic, PC | 1240 Jesse Jewell Sepkwy, Suite 300, Gainesville, GA 30501-3861 |
| Andrew B Reisman | Family Medicine | The Longstreet Clinic, PC | 4222 Fairbanks Dr, Oakwood, GA 30566-2811 |
| David A Bray | Internal Medicine | The Longstreet Clinic, PC | 541 Historic Hwy 441-n, Demorest, GA 30535 |
| Mark D Clark | Nurse Practitioner | The Longstreet Clinic, PC | 725 Jesse Jewell Sepkwy, Suite 300, Gainesville, GA 30501-3846 |
| Eileen Dalmacio Javellana | Internal Medicine | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Brandi N Monroe | Physician Assistant | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Jeanette Susan Pirkle | Nurse Practitioner | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Street Address |
725 JESSE JEWELL PKWY SUITE 150 |
| City | GAINESVILEL |
| State | GA |
| Zip | 30501-3834 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Erica Mcdaniel Abney | Physician Assistant | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Eileen Dalmacio Javellana | Internal Medicine | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Brandi N Monroe | Physician Assistant | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Jeanette Susan Pirkle | Nurse Practitioner | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Jeremiah John Spearman | Physician Assistant | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Danny Shane Webb | Nurse Practitioner | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Marti R Gibbs | Family Medicine | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Anup K Lahiry | Hematology/oncology | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Kelli N Adams | Nurse Practitioner | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Crystal Ann Terrill | Obstetrics/gynecology | The Longstreet Clinic, PC | 725 Jesse Jewell Pkwy, Suite 150, Gainesvilel, GA 30501-3834 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leroy W Robinson Iii | Optometry | Lanier Eye Associates, LLC | 625 S Enota Nedr, Gainesville, GA 30501 |
| William C Ackerman | Ophthalmology | Lanier Eye Associates, LLC | 625 S Enota Nedr, Gainesville, GA 30501 |
| Julius Nathaniel Skeete | Optometry | 150 Pearl Nix Pkwy, D3a, Gainesville, GA 30501-0001 | |
| William T Crews | Chiropractic | 1864 Thompson Bridge Rd, Gainesville, GA 30501-1119 | |
| Julia H Strong | Clinical Social Worker | 1709 B Cleveland Hwy, Gainesville, GA 30501-1353 | |
| Kathryn W. Dudas | Family Medicine | Northeast Georgia Physicians Group Inc | 1856 Thompson Bridge Rd, Suite 14, Gainesville, GA 30501-1620 |
| Yesenia Delosangeles | Clinical Social Worker | Northeast Georgia Physicians Group Inc | 1856 Thompson Bridge Rd, Suite 14, Gainesville, GA 30501-1620 |
| Christy M Wagner | Family Medicine | Northeast Georgia Physicians Group Inc | 1856 Thompson Bridge Rd, Suite 14, Gainesville, GA 30501-1620 |
| Catherine E Norton | Nurse Practitioner | Northeast Georgia Physicians Group Inc | 1856 Thompson Bridge Rd, Suite 14, Gainesville, GA 30501-1620 |
| Jennifer A Roark | Nurse Practitioner | Northeast Georgia Physicians Group Inc | 1856 Thompson Bridge Rd, Suite 14, Gainesville, GA 30501-1620 |
| Find all physicians in zip 30501 | |||
| City | GAINESVILEL |
| Zip Code | 30501 |
| Specialty | GENERAL SURGERY |
| City + Specialty | GAINESVILEL + GENERAL SURGERY |
Please comment or provide details below to improve the information on Derek Paul Pendarvis.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.