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1017 Fayetteville Road Suite A Atlanta GA 30316-2936 | |
| (404) 324-4190 | |
| (404) 324-4191 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1017 Fayetteville Road, Atlanta, Georgia |
| Authorized Official Name and Position | Dan James Bellor (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 4044869034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1017 Fayetteville Road Suite A Atlanta GA 30316-2936 Ph: (404) 324-4190 | 1017 Fayetteville Road Suite A Atlanta GA 30316-2936 Ph: (404) 324-4190 |
| NPI Number | 1134257827 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 03/30/2019 |
| Medicare PECOS PAC ID | 6800109489 |
|---|---|
| Medicare Enrollment ID | O20150727000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134257827 | NPI | - | NPPES |
| 640804505M | Medicaid | GA | |
| 300023628A | Medicaid | GA | |
| 640804505L | Medicaid | GA | |
| 640804505E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sarah Y Vinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467628974 PECOS PAC ID: 0446449797 Enrollment ID: I20110118000959 |
| Provider Name | Shawn P Allen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437316635 PECOS PAC ID: 5698928596 Enrollment ID: I20121228000327 |
| Provider Name | Rita Mathis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518203546 PECOS PAC ID: 2860646643 Enrollment ID: I20130201000207 |
| Provider Name | Martin Thomas Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760784839 PECOS PAC ID: 7416190947 Enrollment ID: I20130830000269 |
| Provider Name | Shelley-ann Beaubrun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083010961 PECOS PAC ID: 7315263886 Enrollment ID: I20150226001943 |
| Provider Name | Djuana Swift |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740571009 PECOS PAC ID: 8224342811 Enrollment ID: I20150727000914 |
| Provider Name | Sherri Cauthen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427002674 PECOS PAC ID: 0446261820 Enrollment ID: I20150730013758 |
| Provider Name | Nina Mena |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306280664 PECOS PAC ID: 9133465222 Enrollment ID: I20190110001392 |
| Provider Name | Rebecca Pihera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407258502 PECOS PAC ID: 2961742903 Enrollment ID: I20190328003092 |
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