PATRIOT HEALTHCARE OF GEORGIA, LLC (NPI# 1275002636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275002636 |
| Entity Type | Organization |
| Organization Name | PATRIOT HEALTHCARE OF GEORGIA, LLC |
| Practice Address |
1587 Phoenix Boulevard Suite 6 College Park GA 30349 |
| Mailing Address |
100 Arricola Avenue St. Augustine FL 32080 |
| Practice Telephone | 4044356029 |
| Mailing Telephone | 9048254368 |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2018-11-15 |
| Authorized Official Name | DAVID A. CULVER (ADMINISTRATOR) |
| Authorized Official Telephone | 9048254368 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PHC of GA College Park | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| Street Address |
1587 PHOENIX BOULEVARD SUITE 6 |
| City | COLLEGE PARK |
| State | GA |
| Zip Code | 30349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185686 | Kmb Diagnostics | Durable Medical Equipment & Medical Supplies | 941 Flat Shoals Rd, Atlanta, GA 30349 | 2019-10-09 |
| 1114575859 | Justin Vassell | Registered Nurse | 1903 Phoenix Boulevard, Suite 200, College Park, GA 30349 | 2019-08-27 |
| 1841856663 | Kennyetta Danielle Watkins | Counselor | 1431 Riverwalk Ln, Apt. F, College Park, GA 30349 | 2019-05-16 |
| 1669971875 | Ee Consulting Solution | Case Management | 6320 Topaz Tral, Arlanta, GA 30349 | 2018-02-03 |
| 1629595640 | Shayla Bouie | Contractor | 5420 Riverdale Rd Apt D17, Atlanta, GA 30349 | 2017-08-30 |
| 1114475563 | Jasmine V Mccully | Social Worker | 5864 Summergien Lane, College Park, GA 30349 | 2016-09-14 |
| 1639537681 | Shelia Thornton | Counselor | 5856 Seabright Lane, Atlanta, GA 30349 | 2016-02-05 |
| 1346610177 | Joanne Resilard | Nurse Practitioner | 2931 Herron Ln Sw, Atlanta, GA 30349 | 2015-10-06 |
| 1063805091 | Southwest Atlanta Medical & Rehabilitation Clinic LLC | Family Medicine | 495 85 Circle, Suite 100, Atlanta, GA 30349 | 2015-03-16 |
| 1144619586 | Catina Hart | Social Worker | 5737 Old National Highway, Suite 300, Atlanta, GA 30349 | 2015-01-22 |
| Find all providers in zip 30349 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295366292 | B Mata LLC | Family Medicine | 1631 Atlanta Hwy, Gainesville, GA 30504-5942 | 2020-01-28 |
| 1558916056 | Newtown Park Medical Clinic and Geriatrics LLC | Family Medicine | 2880 Old Alabama Rd #300, Johns Creek, GA 30022-5033 | 2019-08-02 |
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1215471479 | Deana Perkins | Family Medicine | 756 Arrowhead Lake Rd, Thomaston, GA 30286-5004 | 2016-12-07 |
| 1255731741 | Jafar Tabatabai M.d. P.C. | Family Medicine | 7961 Highway 92 Ste 100, Woodstock, GA 30189-5209 | 2014-09-03 |
| 1457604381 | Senior Care Plus Limited Liability Company | Family Medicine | 990 Peachtree Industrial Blvd Number 4532, Suwanee, GA 30024-5249 | 2012-10-16 |
| 1053662296 | Community Primary Care of Georgia LLC | Family Medicine | 946 Veterans Pkwy, Barnesville, GA 30204-3771 | 2012-09-27 |
| 1669770954 | J&a Wood, LLC | Family Medicine | 2724 Grey Fox Ct, Haddock, GA 31033-6009 | 2011-03-10 |
| 1043442080 | Sam Peng Md PC | Family Medicine | 1622 Rivergreen Bnd Se, Atlanta, GA 30339-8546 | 2009-08-10 |
| 1134259369 | Rina Eisenstein | Family Medicine | 215 Arbor Creek Way, Roswell, GA 30076-1291 | 2007-03-06 |
| Find all providers with the same taxonomy | ||||
| City | COLLEGE PARK |
| Zip Code | 30349 |
Please comment or provide details below to improve the information on PATRIOT HEALTHCARE OF GEORGIA, LLC.
| 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.