| Atlanta Internal Medicine And Psychiatric Care | |
|
6111 Peachtree Dunwoody Rd Ne # C Atlanta GA 30328-6049 | |
| (770) 313-7300 | |
| (770) 399-0007 |
| Full Name | Atlanta Internal Medicine And Psychiatric Care |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6111 Peachtree Dunwoody Rd Ne # C, Atlanta, Georgia |
| Authorized Official Name and Position | Gregory C Lunceford (CEO) |
| Authorized Official Contact | 7703960232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlanta Internal Medicine And Psychiatric Care 4895 Guilford Forest Dr Sw Atlanta GA 30331-8373 Ph: (770) 317-7300 | Atlanta Internal Medicine And Psychiatric Care 6111 Peachtree Dunwoody Rd Ne # C Atlanta GA 30328-6049 Ph: (770) 313-7300 |
| NPI Number | 1003174624 |
|---|---|
| Provider Enumeration Date | 05/02/2012 |
| Last Update Date | 05/02/2012 |
| Medicare PECOS PAC ID | 4183886245 |
|---|---|
| Medicare Enrollment ID | O20120507000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003174624 | NPI | - | NPPES |
| REF000549852 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 050584 (Georgia) | Primary |
| Provider Name | Gregory C Lunceford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851373047 PECOS PAC ID: 3577637875 Enrollment ID: I20080805000366 |
| Provider Name | Alicia Kay Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639535503 PECOS PAC ID: 3375966898 Enrollment ID: I20200630003159 |
| Provider Name | Destiny A Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740929272 PECOS PAC ID: 7214316587 Enrollment ID: I20220616000118 |
| Provider Name | Limata Ayinke Amoussa Madjibi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184325862 PECOS PAC ID: 3577922822 Enrollment ID: I20230705000228 |
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