JORGE ROBERTO MENJIVAR (NPI# 1740721521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740721521 |
| Entity Type | Individual |
| Full Name | JORGE ROBERTO MENJIVAR |
| Credential | NP-C |
| Practice Address |
1631 Highway 20 W Mcdonough GA 30253-7311 |
| Practice Telephone | 7702882822 |
| Practice Fax Number | 7706928177 |
| Mailing Telephone | 7702882822 |
| Mailing Fax Number | 7706928177 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN204394 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | LICENSE | RN204394 | 01 |
| Street Address |
1631 HIGHWAY 20 W |
| City | MCDONOUGH |
| State | GA |
| Zip Code | 30253-7311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245237700 | Allan B Imes Jr. | Physician Assistant | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2005-06-30 |
| 1225587280 | Family Medical Associates, LLC | Family Medicine | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2016-09-30 |
| 1871982124 | Vladimir Odinets | Physician Assistant | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2015-01-09 |
| 1023406162 | Stephanie E Chandler | Clinical Nurse Specialist | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2014-12-23 |
| 1346505179 | Robert T Sikes | Physician Assistant | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2012-07-09 |
| 1427146125 | Jeffrey Scott Reed | Family Medicine | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2006-10-10 |
| 1922040781 | Coral Rochelle Benge | Physician Assistant | 1631 Highway 20 W, Mcdonough, GA 30253-7311 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565159 | First Choice Home Health Care LLC | In Home Supportive Care | 600 Westridge Parkway, Suite 707, Mcdonough, GA 30253 | 2020-10-15 |
| 1164033783 | Tanequa S Dorsey | Counselor | 40 Macon Street, Suite D, Mcdonough, GA 30253 | 2020-08-17 |
| 1396369195 | Ikponmwosa Obakpolor | Physical Therapist | 234 Village Drive, Mcdonough, GA 30253 | 2020-06-08 |
| 1205392305 | Healthstat Onsite Clinic-henry County | Preventive Medicine | 141 Henry Parkway, Healthstat Clinic, Mcdonough, GA 30253 | 2019-02-13 |
| 1588128557 | Vernette R Mathurin | Licensed Practical Nurse | 97 Atl Street Suite 100, Mcdonough, GA 30253 | 2019-01-24 |
| 1083196836 | Peta-gaye C Pilote | Registered Nurse | 319 Regal Way E, Mcdonough, GA 30253 | 2018-08-29 |
| 1275021586 | Heritage Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 155 Westridge Pkwy Ste 217, Mcdonough, GA 30253 | 2018-04-23 |
| 1457853236 | Sherrille Greene | Counselor | 609 Autumn Leaf Circle, Mcdonough, GA 30253 | 2018-03-07 |
| 1376052696 | Kendra Oreggio | Private Vehicle | 117 Janney Circle, Mcdonough, GA 30253 | 2017-09-29 |
| 1245758788 | Pamela Hobbs | Home Health Aide | 5011 Monarch Dr, Mcdonough, GA 30253 | 2017-09-05 |
| Find all providers in zip 30253 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578986 | Marjorie Sewannyana | Nurse Practitioner | 553 Camano Way, Mcdonough, GA 30253-8377 | 2020-11-03 |
| 1568060846 | Crystaline Joi Prothro | Nurse Practitioner | 4085 Springvale Way, Mcdonough, GA 30252-6872 | 2020-10-09 |
| 1790393064 | Nicole L Smith | Nurse Practitioner | 505 Bingham Dr, Mcdonough, GA 30253-8050 | 2020-07-22 |
| 1528676046 | Joseph Ndangoh Fongod | Nurse Practitioner | 1289 Heartwood Ave, Mcdonough, GA 30253-3070 | 2020-07-21 |
| 1881211233 | Adelaida L. Mayeta Peart | Nurse Practitioner | 208 Shelton Dr, Mcdonough, GA 30252-3124 | 2020-07-01 |
| 1619593886 | Heather E Cameron | Nurse Practitioner | 50 Kelly Rd Ste 200, Mcdonough, GA 30253-6097 | 2020-06-23 |
| 1023631157 | Catherine A Nkongho | Nurse Practitioner | 437 Concord Cir, Mcdonough, GA 30253-8001 | 2020-05-23 |
| 1336774876 | Alvin O Mcdonald | Nurse Practitioner | 312 Horsehill St, Mcdonough, GA 30253-4666 | 2020-03-05 |
| 1376178798 | Hannah Lynn Mccall | Nurse Practitioner | 437 Stallsworth Rd, Mcdonough, GA 30252-6140 | 2020-03-05 |
| 1376177295 | Sandy Zachery | Nurse Practitioner | 526 Bentley Way, Mcdonough, GA 30253-3762 | 2020-02-29 |
| Find all providers in MCDONOUGH | ||||
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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.