VISTAS MEDICAL CENTER,PC (NPI# 1104064815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104064815 |
| Entity Type | Organization |
| Organization Name | VISTAS MEDICAL CENTER,PC |
| Practice Address |
5329 Memorial Dr Ste A Stone Mountain GEORGIA 30083 UM |
| Mailing Address |
Po Box 870828 Stone Mountain GA 30087-0027 |
| Practice Telephone | 4042967695 |
| Practice Fax Number | 4042967696 |
| Mailing Telephone | 4042967695 |
| Mailing Fax Number | 4042967696 |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2011-10-21 |
| Authorized Official Name | NICHOLAS KEMDI IHENACHO (MD/CEO) |
| Authorized Official Telephone | 4042967695 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
GA038149 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000727108D | 05 | |
| GA | WELLCARE | 321313 | 01 |
| Street Address |
5329 MEMORIAL DR STE A |
| City | STONE MOUNTAIN |
| State | GEORGIA |
| Zip Code | 30083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730604620 | Nnenna Beatrice Otaluka | Nurse Practitioner | 5329 Memorial Dr Ste A, Stone Mountain, GA 30083-3212 | 2017-08-11 |
| 1821424243 | Vistas Home Care, Inc. | Respite Care | 5329 Memorial Dr Ste A, Stone Mountain, GA 30083-3212 | 2013-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1710403431 | Trans Med Ems,llc | Ambulance | 4683 Redan Rd, Stone Mountain, GA 30083 | 2017-08-15 |
| 1447770482 | Dispatched Angels Home Care | In Home Supportive Care | 619 El Prado Court, Stone Mountain, GA 30083 | 2017-06-21 |
| 1396191086 | Suzanne Carter | Chore Provider | 1036 Allgood Rd, Stone Mountain, GA 30083 | 2016-05-11 |
| 1437520087 | Meaza Dada | Pharmacist | 1043 Thornwoode Lane, Stone Mountain, GA 30083 | 2015-10-08 |
| 1427436500 | Raeanne Elizabeth Gialanella | Occupational Therapist | 5839 Memorial Drive, Stone Mountain, GA 30083 | 2015-05-11 |
| 1265829824 | Latore Williams | Licensed Practical Nurse | 5300 Ridge Forest Drive, Stone Mountain, GA 30083 | 2015-04-22 |
| 1144625922 | Granville Theodore Freeman IIi | Counselor | 5000 Brittany Drive, Stone Mountain, GA 30083 | 2014-10-23 |
| 1588974208 | Terri R Collins | Counselor | 1020 Strap Hinge Trail, Stone Mountain, GA 30083 | 2010-10-15 |
| 1578720470 | Gary L Howard | Technician/Technologist | 5615 #g Memorial Drive, Stone Mountain, GA 30083 | 2008-05-19 |
| Find all providers in zip 30083 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972036978 | Waterworksnow, Incorporated | Clinic/Center | 1525 E Park Place Blvd, Suite 1800, Stone Mountain, GA 30087-3453 | 2017-04-06 |
| City | STONE MOUNTAIN |
| Zip Code | 30083 |
Please comment or provide details below to improve the information on VISTAS MEDICAL CENTER,PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.