MIRIAM P GWATHNEY (DO) – Family Medicine Physician, NPI 1881698546
Family Medicine Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
3,102 FAMILY PRACTICE in GA
Provider Addresses for MIRIAM P GWATHNEY (DO)
101 BANKS STATION
KAISER PERMANENTE FAYETTE MEDICAL OFFICE
FAYETTEVILLE, GA 30214
Phone: (678) 610-3700
Fax: (404) 417-2910
Type: Location
1057 MAIN ST
FOREST PARK, GA 302971482
Phone: (404) 301-4555
Fax: (404) 301-4482
Type: Mailing
3495 PIEDMONT RD NE
NINE PIEDMONT CENTER
ATLANTA, GA 303051717
Phone: (404) 504-5678
Fax: (404) 417-2910
Type: Mailing
101 BANKS STA
KAISER PERMANENTE FAYETTE MEDICAL OFFICE
FAYETTEVILLE, GA 302147507
Phone: (678) 610-3700
Fax: (404) 417-2910
Type: Location
Piedmont Road Northeast, Buckhead, Atlanta, Georgia, 30305, United States
NINE PIEDMONT CENTER
ATLANTA, GA 30305
Phone: (404) 504-5678
Fax: (404) 417-2910
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-10-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101214000806 | I | Family Practice | GA | TBD |
| I20251029003085 | I | Family Practice | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30214)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | GA | 83036 | Hemoglobin A1C level | 21 | 21 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | MO | |
| P O D I A T R Y | NM | |
| - | TX | |
| - | NM | |
| Physician Assistant | NM | |
| - | CO | |
| Diagnostic Radiology | MI | |
| Certified Registered Nurse Anesthetist (Crna) | NM | |
| - | NM | |
| Certified Registered Nurse Anesthetist (Crna) | AZ |
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