| Nurocoach Medical Group Pllc | |
|
2585 Gresham Rd Se Ste 100 Atlanta GA 30316-4147 | |
| (855) 954-6876 | |
| (855) 859-6876 |
| Full Name | Nurocoach Medical Group Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2585 Gresham Rd Se Ste 100, Atlanta, Georgia |
| Authorized Official Name and Position | Taccara Ross (OFFICE MANAGER) |
| Authorized Official Contact | 2258037877 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nurocoach Medical Group Pllc 101 Southwestern Blvd Ste 200 Sugar Land TX 77478-3568 Ph: (855) 954-6876 | Nurocoach Medical Group Pllc 2585 Gresham Rd Se Ste 100 Atlanta GA 30316-4147 Ph: (855) 954-6876 |
| NPI Number | 1083332845 |
|---|---|
| Provider Enumeration Date | 08/18/2022 |
| Last Update Date | 10/09/2023 |
| Certification Date | 10/09/2023 |
| Medicare PECOS PAC ID | 3173991619 |
|---|---|
| Medicare Enrollment ID | O20221115000983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083332845 | NPI | - | NPPES |
| 1174022248 | Medicaid | TX | |
| 1235631599 | Medicaid | TX | |
| 1902217581 | Medicaid | LA | |
| 003291441A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mahesh R Dave |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386651818 PECOS PAC ID: 7214107457 Enrollment ID: I20110826000435 |
| Provider Name | Nalini M Dave |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013923523 PECOS PAC ID: 3678743812 Enrollment ID: I20110826000466 |
| Provider Name | Farah A Buck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508340456 PECOS PAC ID: 4880927664 Enrollment ID: I20190611000049 |
| Provider Name | Brian Zachariah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093126302 PECOS PAC ID: 5991038416 Enrollment ID: I20190614000346 |
| Provider Name | Suzanne Mehaffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194379503 PECOS PAC ID: 2769713213 Enrollment ID: I20191014003122 |
| Provider Name | Sanket A Vyas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932263613 PECOS PAC ID: 7719071364 Enrollment ID: I20201015001767 |
| Provider Name | Richard E Seldeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326614223 PECOS PAC ID: 6709281207 Enrollment ID: I20210821000314 |
| Provider Name | Angela Newbern |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548653751 PECOS PAC ID: 6709258551 Enrollment ID: I20230206000251 |
| Provider Name | Jamie Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174792238 PECOS PAC ID: 3274999081 Enrollment ID: I20230602001157 |
| Provider Name | David J Memmoli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891978607 PECOS PAC ID: 0244364347 Enrollment ID: I20230714002565 |
| Provider Name | Ghislaine Tonye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679160949 PECOS PAC ID: 6800255894 Enrollment ID: I20230824001132 |
| Provider Name | Garic Grisbaum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902217581 PECOS PAC ID: 6002223252 Enrollment ID: I20231107003667 |
| Provider Name | Mario Alejandro Molina Condal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841734449 PECOS PAC ID: 4880038744 Enrollment ID: I20240219002536 |
| Provider Name | Sabrina Lou Lydon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275316226 PECOS PAC ID: 0143664029 Enrollment ID: I20240219003359 |
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