BLISS PRIMARY AND URGENT CARE PC (NPI# 1659874287) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659874287 |
| Entity Type | Organization |
| Organization Name | BLISS PRIMARY AND URGENT CARE PC |
| Practice Address |
4600 E Ponce De Leon Ave Ste A Clarkston GA 30021-1839 |
| Practice Telephone | 4048082125 |
| Practice Fax Number | 8777795837 |
| Mailing Telephone | 4048082125 |
| Mailing Fax Number | 8777795837 |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-03-09 |
| Authorized Official Name | DR. MILES JOHNSON (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 4046644578 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4600 E PONCE DE LEON AVE STE A |
| City | CLARKSTON |
| State | GA |
| Zip Code | 30021-1839 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043781420 | Clarkston Primary & Urgent Care, LLC | Family Medicine | 4600 E Ponce De Leon Ave Ste A, Clarkston, GA 30021-1839 | 2018-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578081808 | Marqueta A Coffer | Case Manager/Care Coordinator | 1380 Brockett Pl, Clarkston, GA 30021 | 2017-09-07 |
| 1063965143 | Bertukan Worku Demas | Pharmacist | 3671 Cobble Mill Ln, Clarkston, GA 30021 | 2016-07-26 |
| 1912341967 | Esther Kim | Family Medicine | 887 N Indian Creek Dr Ste A, Clarkston, GA 30021 | 2013-04-22 |
| 1265739437 | Carepoint Home Care, LLC | In Home Supportive Care | 4122 E Ponce Deleon Avenue, Unit 9, Clarkston, GA 30021 | 2011-02-23 |
| 1790956530 | Thu D. Vu | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
| 1740310630 | Gentle Dental | Dentist | 3595 Hill St., Clarkston, GA 30021 | 2007-03-07 |
| 1679528491 | Ojoru Osunkoya | Pediatrics | 4112 E. Ponce De Leon, Clarkston, GA 30021 | 2006-05-23 |
| 1700849825 | Regina Allen Hardin | Pediatrics | 4112 E. Ponce De Leon Avenue, Clarkston, GA 30021 | 2006-04-10 |
| 1831514538 | Caudelle & Wilson Eye Care LLC | Optometrist | 320 N Jeff Davis Drive, Suite A, Fayetteville, GA 30021 | 2014-03-04 |
| 1881865624 | Vanessa Phan | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
| Find all providers in zip 30021 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033767223 | William Bodnar | Nurse Practitioner | 3701 College Ave, Clarkston, GA 30021-2508 | 2019-08-30 |
| 1619537636 | Samina A. Damani | Nurse Practitioner | 3700 Market St Ste E, Clarkston, GA 30021-2600 | 2019-06-20 |
| 1457911281 | Megan Clemence | Nurse Practitioner | 7210 N Main St Ste 200, Clarkston, MI 48346-1575 | 2019-06-14 |
| 1821577479 | Jerrica Kallio | Nurse Practitioner | 909 Verdi Way, Clarkston, GA 30021-1057 | 2018-08-13 |
| 1346731866 | Wanda M Lewis | Nurse Practitioner | 10112 Windy Knoll Ct, Clarkston, MI 48348-2182 | 2018-05-21 |
| 1104334846 | Tiffany Johnson | Nurse Practitioner | 1040 Noble Vines Dr Apt 2, Clarkston, GA 30021-1345 | 2018-01-16 |
| 1720596802 | Kenzie Gardner | Nurse Practitioner | 7643 Olde Sturbridge Trl, Clarkston, MI 48348-4613 | 2018-01-11 |
| 1245767631 | Eric Dudenhofer Arnp Ps | Nurse Practitioner | 1271 Highland Ave # B, Clarkston, WA 99403-2846 | 2017-05-16 |
| 1710343181 | Teri Massey | Nurse Practitioner | 518 Sunrise Dr, Clarkston, MI 48348-1493 | 2016-01-14 |
| 1275998833 | Joyce John | Nurse Practitioner | 4378 Bluff Pointe, Clarkston, MI 48348-5081 | 2015-12-28 |
| Find all providers in CLARKSTON | ||||
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| 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.