| Whitefoord, Inc. | |
|
1401 Hosea Williams Dr Se Atlanta GA 30317-1703 | |
| (404) 373-6614 | |
| Not Available |
| Full Name | Whitefoord, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1401 Hosea Williams Dr Se, Atlanta, Georgia |
| Authorized Official Name and Position | Craig Tindall (CEO) |
| Authorized Official Contact | 4043736614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitefoord, Inc. 1353 George W Brumley Way Se Atlanta GA 30317-1743 Ph: (404) 523-2500 | Whitefoord, Inc. 1401 Hosea Williams Dr Se Atlanta GA 30317-1703 Ph: (404) 373-6614 |
| NPI Number | 1730305004 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 02/22/2021 |
| Medicare PECOS PAC ID | 1456583723 |
|---|---|
| Medicare Enrollment ID | O20140502001158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730305004 | NPI | - | NPPES |
| 85000942G | Medicaid | GA | |
| 85002417G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Georgia) | Primary |
| Provider Name | Tasha Green |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477578797 PECOS PAC ID: 3476789355 Enrollment ID: I20131125000340 |
| Provider Name | Rose Kombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285169185 PECOS PAC ID: 2961766340 Enrollment ID: I20180511000687 |
| Provider Name | Amina C Porter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659433696 PECOS PAC ID: 1153673405 Enrollment ID: I20181015001662 |
| Provider Name | Lanika Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437683133 PECOS PAC ID: 5092128496 Enrollment ID: I20210104000254 |
| Provider Name | Mary Lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215450234 PECOS PAC ID: 1850659673 Enrollment ID: I20210205001315 |
| Provider Name | Chivon Vanessa Brown Stubbs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700380003 PECOS PAC ID: 1052713054 Enrollment ID: I20210714000077 |
| Provider Name | Moise Joseph |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942420419 PECOS PAC ID: 4486693116 Enrollment ID: I20220223001006 |
| Provider Name | Bianca Rickesha Waters |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255867131 PECOS PAC ID: 4688945223 Enrollment ID: I20220727001578 |
| Provider Name | Jacye A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245545946 PECOS PAC ID: 7012384027 Enrollment ID: I20221103003416 |
| Provider Name | Mykal Oshea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881974137 PECOS PAC ID: 8527286632 Enrollment ID: I20230602000827 |
| Provider Name | Andrea Sharae Hanley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700225661 PECOS PAC ID: 2163884487 Enrollment ID: I20230817001503 |
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