Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Royal Blue Medical Center Ga Inc

Organization Sports Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1942845417

Royal Blue Medical Center Ga Inc is a Sports Medicine (Physical Medicine & Rehabilitation) Physician in Lawrenceville, Georgia. Registered with an NPI since 2019.

In the registry since
2019
Specialties on file
4
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

555 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-8703
Phone: (704) 277-1750
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X
Sports Medicine (Physical Medicine & Rehabilitation) Physician Taxonomy 2081S0010X
Sports Medicine (Preventive Medicine) Physician Taxonomy 2083S0010X
Pain Clinic/Center Taxonomy 261QP3300X

Record details

NPI number1942845417
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Omar Ellison — Owner · (704) 277-1750
Other names Royal Blue Medical Center; Royal Blue Medical Center
NPI enumeratedNovember 8, 2019
Last updated in NPPESSeptember 8, 2020
Certification dateSeptember 8, 2020
Mailing address2023 Connonade Dr, Waxhaw, NC 28173-0109

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