PRESTIGE URGENT CARE CENTER (NPI# 1811352487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811352487 |
| Entity Type | Organization |
| Organization Name | PRESTIGE URGENT CARE CENTER |
| Practice Address |
570 Clark Dr Ellenwood GA 30294-2660 |
| Practice Telephone | 8443773784 |
| Mailing Telephone | 8443773784 |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2015-12-23 |
| Authorized Official Name | VERONICA CERVANTES (CEO) |
| Authorized Official Telephone | 8443773784 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
570 CLARK DR |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-2660 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1598373755 | Pediatric Developmental Services | Clinic/Center | 2250 N Druid Hills Rd Ne Ste 265, Atlanta, GA 30329-3141 | 2020-07-14 |
| 1992322549 | Doctorsbeyond Inc. | Clinic/Center | 277 Skyview Court, Newnan, GA 30265 | 2020-06-30 |
| 1366068728 | Wood Health LLC | Clinic/Center | 310 Gold Creek Trl Ste 100, Woodstock, GA 30188-5436 | 2020-06-22 |
| 1790307924 | Cryogen Plus LLC | Clinic/Center | 1039 Grant St Se Bldg A, Atlanta, GA 30315-2014 | 2020-05-11 |
| 1174154496 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 2305 Abutment Rd, Dalton, GA 30721-4881 | 2020-01-27 |
| 1447881768 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 2225 S Hamilton St, Dalton, GA 30721-4975 | 2020-01-27 |
| Find all providers with the same taxonomy | ||||
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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.