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950 Dannon Vw Sw Ste 4101 Atlanta GA 30331-2159 | |
| (404) 944-1174 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 950 Dannon Vw Sw Ste 4101, Atlanta, Georgia |
| Authorized Official Name and Position | Tyronjala Gainey- Grant (CEO) |
| Authorized Official Contact | 4049441174 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
425 Dutchview Dr Atlanta GA 30349-7642 Ph: () - | 950 Dannon Vw Sw Ste 4101 Atlanta GA 30331-2159 Ph: (404) 944-1174 |
| NPI Number | 1164035564 |
|---|---|
| Provider Enumeration Date | 08/25/2020 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Medicare PECOS PAC ID | 4688094980 |
|---|---|
| Medicare Enrollment ID | O20201026000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164035564 | NPI | - | NPPES |
| Provider Name | Ayjanah Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871908095 PECOS PAC ID: 8628299278 Enrollment ID: I20141023000414 |
| Provider Name | Tyronjala Shontel Gainey-grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659615342 PECOS PAC ID: 5597185892 Enrollment ID: I20201102002049 |
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