| Grady Memorial Hospital Corporation | |
|
3896 Princeton Lakes Way Atlanta GA 30331 | |
| (404) 616-8880 | |
| Not Available |
| Full Name | Grady Memorial Hospital Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 3896 Princeton Lakes Way, Atlanta, Georgia |
| Authorized Official Name and Position | Tamara Anne Nilmeier (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 4046168880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grady Memorial Hospital Corporation 80 Jesse Hill Jr Dr Se # 26042 Atlanta GA 30303-3031 Ph: (404) 616-8880 | Grady Memorial Hospital Corporation 3896 Princeton Lakes Way Atlanta GA 30331 Ph: (404) 616-8880 |
| NPI Number | 1649765686 |
|---|---|
| Provider Enumeration Date | 06/22/2018 |
| Last Update Date | 06/22/2018 |
| Medicare PECOS PAC ID | 7517032998 |
|---|---|
| Medicare Enrollment ID | O20181107003377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649765686 | NPI | - | NPPES |
| 060-641 | Other | GA | BUSINESS PERMIT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Renee E Corley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972605624 PECOS PAC ID: 9436121118 Enrollment ID: I20040812000296 |
| Provider Name | Oluwayemisi O Ibraheem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649296039 PECOS PAC ID: 9234199373 Enrollment ID: I20041013001074 |
| Provider Name | William C Small |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700842473 PECOS PAC ID: 4082666243 Enrollment ID: I20050216000001 |
| Provider Name | Paula L Pollard Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366518409 PECOS PAC ID: 3870492648 Enrollment ID: I20051007000163 |
| Provider Name | Nitasha Burney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083665491 PECOS PAC ID: 4981654670 Enrollment ID: I20051115000160 |
| Provider Name | Michael Flood |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437182391 PECOS PAC ID: 3678588514 Enrollment ID: I20060214000009 |
| Provider Name | Aparna R Kakarala |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801864186 PECOS PAC ID: 9335113844 Enrollment ID: I20070106000072 |
| Provider Name | Dale A Wilmot |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629199559 PECOS PAC ID: 5890874739 Enrollment ID: I20080505000341 |
| Provider Name | Cheryl Franklin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1679571277 PECOS PAC ID: 0143396465 Enrollment ID: I20080910000030 |
| Provider Name | Kathleen R Gundry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760416788 PECOS PAC ID: 6608992177 Enrollment ID: I20100922000570 |
| Provider Name | Priya Dharshini Ravindran |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1033167333 PECOS PAC ID: 1355371808 Enrollment ID: I20101229000440 |
| Provider Name | Glenda Wrenn Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750447496 PECOS PAC ID: 6406943646 Enrollment ID: I20110726000071 |
| Provider Name | Anna Holbrook |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558590588 PECOS PAC ID: 0143351049 Enrollment ID: I20110926000697 |
| Provider Name | Chrystal D Hawkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245501592 PECOS PAC ID: 1456515469 Enrollment ID: I20120601000505 |
| Provider Name | Brandi W Quinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932475639 PECOS PAC ID: 7214193465 Enrollment ID: I20120717000034 |
| Provider Name | Sameia Mohammed Udoji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114285509 PECOS PAC ID: 8729234034 Enrollment ID: I20120801000737 |
| Provider Name | Nicole King Cotton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760641591 PECOS PAC ID: 1759525561 Enrollment ID: I20130918000080 |
| Provider Name | Lynne Cunningham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1730281189 PECOS PAC ID: 9931323151 Enrollment ID: I20140610000180 |
| Provider Name | Michael Courtney Windham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861697740 PECOS PAC ID: 2668668393 Enrollment ID: I20150331000979 |
| Provider Name | Tiffany L Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144617010 PECOS PAC ID: 8022324516 Enrollment ID: I20150828001198 |
| Provider Name | Samantha Wagner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053756890 PECOS PAC ID: 0345542528 Enrollment ID: I20161003000797 |
| Provider Name | Sherese Stepney Hullaby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992240428 PECOS PAC ID: 4082995188 Enrollment ID: I20170104000821 |
| Provider Name | Faith E Works-fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023552882 PECOS PAC ID: 6800172115 Enrollment ID: I20170420000953 |
| Provider Name | Michelle Harper Allen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255697256 PECOS PAC ID: 2062799828 Enrollment ID: I20170503001575 |
| Provider Name | Saladin Alex Cooper |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659347359 PECOS PAC ID: 0345154639 Enrollment ID: I20170516001991 |
| Provider Name | Diana L Wilson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720159692 PECOS PAC ID: 2264512318 Enrollment ID: I20170609001869 |
| Provider Name | Christopher Mcadams |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659634301 PECOS PAC ID: 1254601776 Enrollment ID: I20170717001428 |
| Provider Name | Kelley Walk Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477582062 PECOS PAC ID: 5597700039 Enrollment ID: I20170822003507 |
| Provider Name | Cleo Stafford |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1962765321 PECOS PAC ID: 1355646191 Enrollment ID: I20171004002536 |
| Provider Name | Fatima Elizabeth Kasiah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750680278 PECOS PAC ID: 3779841259 Enrollment ID: I20171212000666 |
| Provider Name | Paula Gertrude Adamson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1194163105 PECOS PAC ID: 6507160876 Enrollment ID: I20180503001877 |
| Provider Name | Sagar B Amin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912273483 PECOS PAC ID: 5294963484 Enrollment ID: I20180816000849 |
| Provider Name | Neeti Rajendra Bagadiya |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205270816 PECOS PAC ID: 6002166659 Enrollment ID: I20180904000290 |
| Provider Name | Ayushi Gupta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134480288 PECOS PAC ID: 3779854872 Enrollment ID: I20180917001767 |
| Provider Name | Philip Wong |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295172351 PECOS PAC ID: 0244464717 Enrollment ID: I20180919001689 |
| Provider Name | Yolanda H Wimberly |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396745279 PECOS PAC ID: 8820340862 Enrollment ID: I20181002003639 |
| Provider Name | Melvin Ray Echols |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962410746 PECOS PAC ID: 0244333482 Enrollment ID: I20181218001216 |
| Provider Name | Caryl Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346792983 PECOS PAC ID: 1658651443 Enrollment ID: I20190206003277 |
| Provider Name | Sepideh Zohreh |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053880500 PECOS PAC ID: 4284975988 Enrollment ID: I20190408000078 |
| Provider Name | Gloria S Hughes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700266020 PECOS PAC ID: 2062787542 Enrollment ID: I20191217000729 |
| Provider Name | Jesse Marie Conyers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801282066 PECOS PAC ID: 8820429392 Enrollment ID: I20200518000500 |
| Provider Name | Joslyn Nicole Witherspoon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215269873 PECOS PAC ID: 8628224367 Enrollment ID: I20200723003319 |
| Provider Name | Pradnya Mhatre |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700831187 PECOS PAC ID: 9830126127 Enrollment ID: I20200824003447 |
| Provider Name | Julia J Liu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1932165222 PECOS PAC ID: 3971490343 Enrollment ID: I20201124002318 |
| Provider Name | Patricia Balthazar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598147001 PECOS PAC ID: 4981003134 Enrollment ID: I20210520002422 |
| Provider Name | Eshani Sheth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417306655 PECOS PAC ID: 0840690913 Enrollment ID: I20210610001889 |
| Provider Name | Jasmine Nicole Locklin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992184709 PECOS PAC ID: 2668769613 Enrollment ID: I20210610002021 |
| Provider Name | Muhammad Naeem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487035812 PECOS PAC ID: 3274848999 Enrollment ID: I20210614002196 |
| Provider Name | James Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326496225 PECOS PAC ID: 7911293550 Enrollment ID: I20210615000931 |
| Provider Name | Juan Diego Guerrero-calderon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679922603 PECOS PAC ID: 3678859097 Enrollment ID: I20210720003229 |
| Provider Name | Karma Ziad Salem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841652179 PECOS PAC ID: 4981974623 Enrollment ID: I20210729000468 |
| Provider Name | Mohammed Alkubeysi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770923419 PECOS PAC ID: 0648400846 Enrollment ID: I20210818000866 |
| Provider Name | Nabil Calisi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407274319 PECOS PAC ID: 5597067496 Enrollment ID: I20210826000545 |
| Provider Name | Emma E Cermak |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1609190255 PECOS PAC ID: 3870806110 Enrollment ID: I20220907003599 |
Extreme Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2484 Briarcliff Rd Ne, Suite 22-353, Atlanta, GA 30329 Phone: 678-237-6363 | |
Saint Joseph's Mercy Care - Mary Hall Freedom House Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Hannover Park Rd Ste 100, Atlanta, GA 30350 Phone: 678-843-8500 Fax: 678-843-8601 | |
Physicians Care Centers Of Atlanta, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 285 Boulevard Ne, Suite 435, Atlanta, GA 30312 Phone: 561-385-0731 | |
Tis (to Inspire Strong) African Children Fund, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2233 Peachtree Rd Ne Ste 206a, Atlanta, GA 30309 Phone: 202-872-8333 | |
Comfort Medical Center Phoenix Blvd, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1903 Phoenix Blvd Ste 125, Atlanta, GA 30349 Phone: 404-982-4228 Fax: 404-275-0676 | |
Aylo Health, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3333 Riverwood Pkwy Se Ste 250, Atlanta, GA 30339 Phone: 770-914-0116 Fax: 770-914-7703 | |
Cardiac Disease Specialists, Pc- Sheffield Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1938 Peachtree Rd Nw, Ste 412, Atlanta, GA 30309 Phone: 404-351-3231 Fax: 404-351-3167 |