| Centerwell Senior Primary Care Ga Pc | |
|
6085 Old National Hwy Ste G South Fulton GA 30349-4333 | |
| (470) 754-6360 | |
| (877) 780-7359 |
| Full Name | Centerwell Senior Primary Care Ga Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6085 Old National Hwy Ste G, South Fulton, Georgia |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerwell Senior Primary Care Ga Pc 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | Centerwell Senior Primary Care Ga Pc 6085 Old National Hwy Ste G South Fulton GA 30349-4333 Ph: (470) 754-6360 |
| NPI Number | 1801463468 |
|---|---|
| Provider Enumeration Date | 06/10/2021 |
| Last Update Date | 07/03/2024 |
| Medicare PECOS PAC ID | 3274939061 |
|---|---|
| Medicare Enrollment ID | O20210901004313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801463468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gloria A Richards |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043311186 PECOS PAC ID: 1456318088 Enrollment ID: I20041215000899 |
| Provider Name | Valda O Gibson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205851425 PECOS PAC ID: 7315985967 Enrollment ID: I20050422001019 |
| Provider Name | Irene Ayoyinka Omotoso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205848785 PECOS PAC ID: 6608765193 Enrollment ID: I20050509000621 |
| Provider Name | Adebukola O Akintoye |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447380019 PECOS PAC ID: 4587696927 Enrollment ID: I20050907000058 |
| Provider Name | Sonia Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538178728 PECOS PAC ID: 9739072380 Enrollment ID: I20060920000228 |
| Provider Name | Abiola Ojewole |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306011077 PECOS PAC ID: 4981769346 Enrollment ID: I20090218000409 |
| Provider Name | Jane Campbell Dunlap |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134361686 PECOS PAC ID: 7719039536 Enrollment ID: I20090708000715 |
| Provider Name | John Joseph Oliga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013021781 PECOS PAC ID: 4688729080 Enrollment ID: I20090909000275 |
| Provider Name | Dmitriy M Pelishev |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457400251 PECOS PAC ID: 9436246659 Enrollment ID: I20091028000423 |
| Provider Name | Kristy Z Levarity Conley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760672281 PECOS PAC ID: 6204021223 Enrollment ID: I20101116000318 |
| Provider Name | Osabuohien Usifo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750385662 PECOS PAC ID: 4981884640 Enrollment ID: I20110211000927 |
| Provider Name | Rita Claxton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306855655 PECOS PAC ID: 9638178148 Enrollment ID: I20110906000535 |
| Provider Name | Katina Melissa New |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821287046 PECOS PAC ID: 8729244389 Enrollment ID: I20120725000936 |
| Provider Name | Patrice Y Marshall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518083617 PECOS PAC ID: 6002067394 Enrollment ID: I20121114000378 |
| Provider Name | Denni M Savage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851732416 PECOS PAC ID: 9638311517 Enrollment ID: I20130805000878 |
| Provider Name | Alexis Atwater |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922328830 PECOS PAC ID: 9537303854 Enrollment ID: I20130926000119 |
| Provider Name | Sherika S Newman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740442599 PECOS PAC ID: 6103993233 Enrollment ID: I20140311001582 |
| Provider Name | Lenise M Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639595309 PECOS PAC ID: 3476778085 Enrollment ID: I20140715000928 |
| Provider Name | Wendy Swayne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730580010 PECOS PAC ID: 6103048947 Enrollment ID: I20141112001039 |
| Provider Name | David R Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366863532 PECOS PAC ID: 2466671573 Enrollment ID: I20141201001829 |
| Provider Name | Meredith Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710386883 PECOS PAC ID: 2860719291 Enrollment ID: I20150324002240 |
| Provider Name | Candace Charysse White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932495215 PECOS PAC ID: 9739472788 Enrollment ID: I20160728000093 |
| Provider Name | Kimberly N Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265987184 PECOS PAC ID: 5890081020 Enrollment ID: I20160914000602 |
| Provider Name | Emily Battaglia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508300690 PECOS PAC ID: 2668753708 Enrollment ID: I20170103000771 |
| Provider Name | Lonnie Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639616089 PECOS PAC ID: 7911281183 Enrollment ID: I20170307002025 |
| Provider Name | Donell D Collins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427499136 PECOS PAC ID: 9032346127 Enrollment ID: I20170901001556 |
| Provider Name | Vannessa Evans |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467968099 PECOS PAC ID: 9638426216 Enrollment ID: I20180728000079 |
| Provider Name | Cristian Carbuccia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790167799 PECOS PAC ID: 0143570960 Enrollment ID: I20180829000423 |
| Provider Name | Jan Delroy Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023518537 PECOS PAC ID: 8628328234 Enrollment ID: I20180831001238 |
| Provider Name | Erica D Ware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942692843 PECOS PAC ID: 2062717341 Enrollment ID: I20190218003055 |
| Provider Name | Michelle Rochard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265890487 PECOS PAC ID: 5890078620 Enrollment ID: I20191228000391 |
| Provider Name | Sara Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861984759 PECOS PAC ID: 9638504327 Enrollment ID: I20200128001031 |
| Provider Name | Debra Ann Stover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679076525 PECOS PAC ID: 9133556269 Enrollment ID: I20200229000199 |
| Provider Name | Leisa Covington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700339728 PECOS PAC ID: 3274962121 Enrollment ID: I20200330000139 |
| Provider Name | Adrienne Laquinn Dudley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720634199 PECOS PAC ID: 4284046251 Enrollment ID: I20201215003403 |
| Provider Name | Stella Royette Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487292694 PECOS PAC ID: 7517379142 Enrollment ID: I20201223001305 |
| Provider Name | Ouida Deedra Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326649351 PECOS PAC ID: 3274946744 Enrollment ID: I20201231000681 |
| Provider Name | April Jonita Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619514437 PECOS PAC ID: 2466865878 Enrollment ID: I20210104000625 |
| Provider Name | Shonkeisha L Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043828106 PECOS PAC ID: 2668885567 Enrollment ID: I20210114001444 |
| Provider Name | Aliya Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881291151 PECOS PAC ID: 0042627655 Enrollment ID: I20210326001814 |
| Provider Name | Tricia Jarrell Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043844830 PECOS PAC ID: 6002147634 Enrollment ID: I20210720000205 |
| Provider Name | Millicent Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841819547 PECOS PAC ID: 3678977568 Enrollment ID: I20210816000618 |
| Provider Name | Jarvis Jeffrey Sanchez-rivera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659521797 PECOS PAC ID: 8628263696 Enrollment ID: I20210910000667 |
| Provider Name | Donessa A Fraser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255561379 PECOS PAC ID: 5698923019 Enrollment ID: I20210915000112 |
| Provider Name | Randa Pycard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851809529 PECOS PAC ID: 0840552550 Enrollment ID: I20211006003226 |
| Provider Name | Jodine Sejour Donatien |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275562332 PECOS PAC ID: 6800819368 Enrollment ID: I20211014000063 |
| Provider Name | Elaine Grimes-dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790453934 PECOS PAC ID: 5799173530 Enrollment ID: I20211027000669 |
| Provider Name | Tamika Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902357510 PECOS PAC ID: 8628321213 Enrollment ID: I20211115001118 |
| Provider Name | Oladunni Funmi Faminu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861040479 PECOS PAC ID: 6709276264 Enrollment ID: I20211124001653 |
| Provider Name | Joseph Fowlkes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568661320 PECOS PAC ID: 3678960911 Enrollment ID: I20220505000153 |
| Provider Name | Robyn Odzark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326487703 PECOS PAC ID: 6901049485 Enrollment ID: I20220520000770 |
| Provider Name | Neva R Allison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346759974 PECOS PAC ID: 9133509615 Enrollment ID: I20220629003313 |
| Provider Name | Jacqueline Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770024671 PECOS PAC ID: 5092061242 Enrollment ID: I20230411000449 |
| Provider Name | Alice Amponsah Asare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134842057 PECOS PAC ID: 6608221304 Enrollment ID: I20231016002754 |
| Provider Name | Aiyesha Stiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306332952 PECOS PAC ID: 2365781457 Enrollment ID: I20231130001183 |
| Provider Name | Taylor B Moran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649866724 PECOS PAC ID: 9133523954 Enrollment ID: I20240710001107 |
| Provider Name | Trickera Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932341682 PECOS PAC ID: 1850440041 Enrollment ID: I20241121001554 |
| Provider Name | James Emerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285364471 PECOS PAC ID: 2365331212 Enrollment ID: I20250124001268 |
| Provider Name | Sahin Coban |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649979923 PECOS PAC ID: 8628430915 Enrollment ID: I20250217001804 |
| Provider Name | John Lacson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104313634 PECOS PAC ID: 5294088837 Enrollment ID: I20250401000264 |
| Provider Name | Rhonda Helvitia Cantu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669923157 PECOS PAC ID: 6901323732 Enrollment ID: I20250506001453 |
| Provider Name | Misty Kelly Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760966337 PECOS PAC ID: 7113445156 Enrollment ID: I20250514001202 |