| The Good Samaritan Health Center, Inc. | |
|
1015 Donald Lee Hollowell Pkwy Nw Atlanta GA 30318-6653 | |
| (404) 523-6571 | |
| (404) 523-6574 |
| Full Name | The Good Samaritan Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1015 Donald Lee Hollowell Pkwy Nw, Atlanta, Georgia |
| Authorized Official Name and Position | William Chester Warren (CEO/FOUNDER/PRESIDENT) |
| Authorized Official Contact | 4045236571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Good Samaritan Health Center, Inc. 1015 Donald Lee Hollowell Pkwy Nw Atlanta GA 30318-6653 Ph: (404) 523-6571 | The Good Samaritan Health Center, Inc. 1015 Donald Lee Hollowell Pkwy Nw Atlanta GA 30318-6653 Ph: (404) 523-6571 |
| NPI Number | 1629254008 |
|---|---|
| Provider Enumeration Date | 01/15/2008 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4082509682 |
|---|---|
| Medicare Enrollment ID | O20040220000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629254008 | NPI | - | NPPES |
| 000915769A | Medicaid | GA | |
| 085002146G | Medicaid | GA | |
| 000282521D | Medicaid | GA | |
| 2238592338B | Medicaid | GA | |
| 000249763E | Medicaid | GA | |
| 00635984B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Georgia) | Primary |
| Provider Name | Melissa Quiros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497948822 PECOS PAC ID: 8820121940 Enrollment ID: I20100727000017 |
| Provider Name | Jeryln L Jones |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639421910 PECOS PAC ID: 5395036974 Enrollment ID: I20160629001603 |
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