| Theramed Health, Llc | |
|
3440 Blue Springs Rd Nw Ste 503 Kennesaw GA 30144-1038 | |
| (404) 857-9575 | |
| (888) 857-4685 |
| Full Name | Theramed Health, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3440 Blue Springs Rd Nw Ste 503, Kennesaw, Georgia |
| Authorized Official Name and Position | Nicole Reed (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4048579575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theramed Health, Llc 3440 Blue Springs Rd Nw Ste 503 Kennesaw GA 30144-1038 Ph: (404) 857-9575 | Theramed Health, Llc 3440 Blue Springs Rd Nw Ste 503 Kennesaw GA 30144-1038 Ph: (404) 857-9575 |
| NPI Number | 1487056586 |
|---|---|
| Provider Enumeration Date | 09/19/2014 |
| Last Update Date | 07/15/2020 |
| Certification Date | 07/15/2020 |
| Medicare PECOS PAC ID | 0345564472 |
|---|---|
| Medicare Enrollment ID | O20150121001157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487056586 | NPI | - | NPPES |
| Provider Name | Charles T Riney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942494711 PECOS PAC ID: 9133219272 Enrollment ID: I20071213000283 |
| Provider Name | Kristin Summey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659530756 PECOS PAC ID: 0446322358 Enrollment ID: I20080710000200 |
| Provider Name | Christina S Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376858746 PECOS PAC ID: 6507050309 Enrollment ID: I20101104001234 |
| Provider Name | Vesselin Stoyanov Raytchev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689926651 PECOS PAC ID: 6103078498 Enrollment ID: I20121213000186 |
| Provider Name | Erika C Kang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639568066 PECOS PAC ID: 2163740911 Enrollment ID: I20150408000610 |
| Provider Name | Anjenette Sorapuru |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508294810 PECOS PAC ID: 6305167800 Enrollment ID: I20150609002811 |
| Provider Name | William B Parks |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1285068288 PECOS PAC ID: 7012211147 Enrollment ID: I20160209002832 |
| Provider Name | Victoria Lynn Fountain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437504966 PECOS PAC ID: 1951600212 Enrollment ID: I20160509001442 |
| Provider Name | Malinda Conrad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922259613 PECOS PAC ID: 4789842154 Enrollment ID: I20170619000199 |
| Provider Name | Alisha Nicole Ashley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124535836 PECOS PAC ID: 7113281882 Enrollment ID: I20180504000025 |
| Provider Name | Amanda L Shafer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720580376 PECOS PAC ID: 3678828217 Enrollment ID: I20180621002549 |
| Provider Name | Enika Mcclain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427576776 PECOS PAC ID: 4587916762 Enrollment ID: I20181017000222 |
| Provider Name | Samantha Danielle Pruitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053876391 PECOS PAC ID: 3274873690 Enrollment ID: I20190321003089 |
| Provider Name | Fenia J Philemond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386135283 PECOS PAC ID: 3476988403 Enrollment ID: I20200121000435 |
| Provider Name | Chantalette Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962049494 PECOS PAC ID: 3870904493 Enrollment ID: I20201202002085 |
| Provider Name | Kayleigh K Pritchett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497306096 PECOS PAC ID: 4385048842 Enrollment ID: I20210804004184 |
| Provider Name | Westly M Francois |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629443932 PECOS PAC ID: 1456629229 Enrollment ID: I20210923000809 |
| Provider Name | Christa Renee Shugan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457018103 PECOS PAC ID: 6305209131 Enrollment ID: I20230828001533 |
| Provider Name | Sydney Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174379218 PECOS PAC ID: 2163964446 Enrollment ID: I20240603002597 |
| Provider Name | Hermanda West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558118463 PECOS PAC ID: 4789126533 Enrollment ID: I20240607000967 |
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