SOUTHEASTERN RHEUMATOLOGY ALLIANCE – Rheumatology Physician, NPI 1114795663
Rheumatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTHEASTERN RHEUMATOLOGY ALLIANCE
700 S ENOTA DR NE
GAINESVILLE, GA 305012403
Phone: (770) 531-3711
Type: Mailing
1715 RESURGENCE DRIVE
Suite 201
WATKINSVILLE, GA 306777306
Phone: (706) 410-9270
Type: Location
23 Plantation Park Dr Ste 101
Bluffton, SC 299106072
Phone: (912) 349-4227
Type: Location
5400 Waters Ave
Savannah, GA 314046234
Phone: (912) 349-4227
Type: Location
980 Johnson Fy Rd NE Ste 220
Atlanta, GA 303421623
Phone: (404) 255-5956
Type: Location
1816 Eagle Dr Ste 200-B
Woodstock, GA 301898274
Phone: (404) 255-5956
Type: Location
110 Rushing Ln Ste B
Statesboro, GA 304586027
Phone: (912) 210-0276
Fax: (912) 428-7201
Type: Location
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: 2024-04-15
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 |
|---|---|---|---|---|
| O20240411001547 | O | Clinic/Group Practice | GA | TBD |
| O20240415001911 | O | Clinic/Group Practice | SC | 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 30501)
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