| Inner Community Health | |
|
2180 Satellite Blvd Ste 400 Duluth GA 30097-4927 | |
| (800) 620-6950 | |
| (877) 290-0408 |
| Full Name | Inner Community Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2180 Satellite Blvd Ste 400, Duluth, Georgia |
| Authorized Official Name and Position | Mirica Sanders (OWNER) |
| Authorized Official Contact | 2165773441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Community Health 2180 Satellite Blvd Ste 400 Duluth GA 30097-4927 Ph: () - | Inner Community Health 2180 Satellite Blvd Ste 400 Duluth GA 30097-4927 Ph: (800) 620-6950 |
| NPI Number | 1891398541 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 11/07/2023 |
| Certification Date | 11/07/2023 |
| Medicare PECOS PAC ID | 8729441852 |
|---|---|
| Medicare Enrollment ID | O20230823000046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891398541 | NPI | - | NPPES |
| 003291824A | Medicaid | GA |
| Provider Name | Susan Furro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548790496 PECOS PAC ID: 5991075384 Enrollment ID: I20170718000835 |
| Provider Name | Olusola Olawale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205327764 PECOS PAC ID: 5496005076 Enrollment ID: I20180830003632 |
| Provider Name | Mariam R Qureshi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801113204 PECOS PAC ID: 5294053831 Enrollment ID: I20181012002433 |
| Provider Name | Tansha Enoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396230413 PECOS PAC ID: 5092138206 Enrollment ID: I20200707001415 |
| Provider Name | Tiona Praylow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013178334 PECOS PAC ID: 7315181336 Enrollment ID: I20210405000576 |
| Provider Name | Stephanie Abel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811506272 PECOS PAC ID: 8426466418 Enrollment ID: I20210412001113 |
| Provider Name | Quinshunda Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871763805 PECOS PAC ID: 3173925682 Enrollment ID: I20210707000447 |
| Provider Name | Mirica Artine Sanders |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336466820 PECOS PAC ID: 6406082213 Enrollment ID: I20220504000674 |
| Provider Name | Beau Daniel Foxworth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497245203 PECOS PAC ID: 2668851098 Enrollment ID: I20220615001592 |
| Provider Name | John Gabriel Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609396035 PECOS PAC ID: 0446526446 Enrollment ID: I20220728001519 |
| Provider Name | Glory Osadiaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003490764 PECOS PAC ID: 7517334295 Enrollment ID: I20221109002437 |
| Provider Name | Kenosha Latrice Tillman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275886103 PECOS PAC ID: 6709249246 Enrollment ID: I20230830003310 |
| Provider Name | Sefiatu Abu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982391629 PECOS PAC ID: 4789047242 Enrollment ID: I20230830003996 |
| Provider Name | Andriea Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124537063 PECOS PAC ID: 8729441209 Enrollment ID: I20230831000389 |
| Provider Name | Shaquanda Shantivus Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891475430 PECOS PAC ID: 9638532096 Enrollment ID: I20230831004487 |
| Provider Name | Marilyn Rankin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952606303 PECOS PAC ID: 7012257264 Enrollment ID: I20231128002839 |
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