| Hardy Renew Wellness,llc | |
|
838 Cannon Run Sw Marietta GA 30064-4600 | |
| (423) 443-9956 | |
| Not Available |
| Full Name | Hardy Renew Wellness,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 838 Cannon Run Sw, Marietta, Georgia |
| Authorized Official Name and Position | Leanthony Hardy (OWNER) |
| Authorized Official Contact | 2127346621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hardy Renew Wellness,llc 1430 Georgia Ave East Point GA 30344-4329 Ph: (212) 734-6621 | Hardy Renew Wellness,llc 838 Cannon Run Sw Marietta GA 30064-4600 Ph: (423) 443-9956 |
| NPI Number | 1952914368 |
|---|---|
| Provider Enumeration Date | 08/25/2020 |
| Last Update Date | 05/30/2023 |
| Medicare PECOS PAC ID | 2961812425 |
|---|---|
| Medicare Enrollment ID | O20201112000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952914368 | NPI | - | NPPES |
| 1629053277 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Rondrick E Williamson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1902821242 PECOS PAC ID: 6901792043 Enrollment ID: I20040225000532 |
| Provider Name | James Rogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982704300 PECOS PAC ID: 5597740217 Enrollment ID: I20040618000574 |
| Provider Name | Leanthony A Hardy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629053277 PECOS PAC ID: 5395722185 Enrollment ID: I20040630000359 |
| Provider Name | Xavier C Moore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982787297 PECOS PAC ID: 7810924594 Enrollment ID: I20050725000692 |
| Provider Name | Iris A Castro Revoredo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801984562 PECOS PAC ID: 1052312311 Enrollment ID: I20070130000046 |
| Provider Name | Bernard G Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356441737 PECOS PAC ID: 2062414287 Enrollment ID: I20081007000661 |
| Provider Name | Terry L Dickerson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1598766313 PECOS PAC ID: 7012070741 Enrollment ID: I20090107000209 |
| Provider Name | Christina Daniels Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871666404 PECOS PAC ID: 6204964943 Enrollment ID: I20100517000599 |
| Provider Name | Anand Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669705505 PECOS PAC ID: 9436295227 Enrollment ID: I20100816000046 |
| Provider Name | Emem B Udo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801073465 PECOS PAC ID: 0749476299 Enrollment ID: I20101123000150 |
| Provider Name | Linda J Wynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124268784 PECOS PAC ID: 5496937252 Enrollment ID: I20110315000849 |
| Provider Name | Calita S Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528295078 PECOS PAC ID: 5193902302 Enrollment ID: I20110615000308 |
| Provider Name | Tiwalade Olawuyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114212115 PECOS PAC ID: 3375711039 Enrollment ID: I20110722000678 |
| Provider Name | Roxanne E Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396942256 PECOS PAC ID: 9133215361 Enrollment ID: I20111031000162 |
| Provider Name | Constance B Knowles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821372236 PECOS PAC ID: 1951574037 Enrollment ID: I20111107000005 |
| Provider Name | Leah Elrod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780932939 PECOS PAC ID: 4284881947 Enrollment ID: I20120831000103 |
| Provider Name | Michele Asa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922376417 PECOS PAC ID: 5294986584 Enrollment ID: I20121114000363 |
| Provider Name | Erica C Bolar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285995845 PECOS PAC ID: 0840437208 Enrollment ID: I20130503000048 |
| Provider Name | Carol S Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932258274 PECOS PAC ID: 8820231947 Enrollment ID: I20130821000273 |
| Provider Name | Abhay J Deshmukh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861726481 PECOS PAC ID: 6305087834 Enrollment ID: I20140506000387 |
| Provider Name | Monifa K Montique |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790188605 PECOS PAC ID: 2163741661 Enrollment ID: I20150505002053 |
| Provider Name | Alvin F Cowans |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1164812202 PECOS PAC ID: 9739496944 Enrollment ID: I20150921003205 |
| Provider Name | Erica T Isom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285991588 PECOS PAC ID: 7618286287 Enrollment ID: I20151021002353 |
| Provider Name | Mariana Sirbu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629445192 PECOS PAC ID: 0244540466 Enrollment ID: I20151030000297 |
| Provider Name | Kadallah Z Brandy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689839482 PECOS PAC ID: 0446429542 Enrollment ID: I20160801000243 |
| Provider Name | Benjamin Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104212869 PECOS PAC ID: 4385930924 Enrollment ID: I20160908001685 |
| Provider Name | Lashaun Denise Elliott |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497074298 PECOS PAC ID: 8628225240 Enrollment ID: I20161003000860 |
| Provider Name | Nicole L Mosley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700324043 PECOS PAC ID: 4183908346 Enrollment ID: I20170307001595 |
| Provider Name | Kedric J Naylor |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023375607 PECOS PAC ID: 6406176692 Enrollment ID: I20170803003372 |
| Provider Name | Debra D Durden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568997914 PECOS PAC ID: 0941573752 Enrollment ID: I20170830000779 |
| Provider Name | Roberta A Walters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053840959 PECOS PAC ID: 6103190491 Enrollment ID: I20170926001310 |
| Provider Name | Deaudrey S Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851817886 PECOS PAC ID: 8022384171 Enrollment ID: I20171018000696 |
| Provider Name | Dina Adimora-onwuka |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1568780252 PECOS PAC ID: 4587886056 Enrollment ID: I20171219000689 |
| Provider Name | Aritha Geraldine Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902328297 PECOS PAC ID: 8325306137 Enrollment ID: I20171228001670 |
| Provider Name | Jodie J Salo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215078902 PECOS PAC ID: 8224355268 Enrollment ID: I20180510002579 |
| Provider Name | Lilian Mugwede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629580196 PECOS PAC ID: 6002198611 Enrollment ID: I20180518002524 |
| Provider Name | Dana M Knight-king |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831598721 PECOS PAC ID: 0244544625 Enrollment ID: I20180519000089 |
| Provider Name | Sasha Morton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518488972 PECOS PAC ID: 2769739937 Enrollment ID: I20180718003461 |
| Provider Name | Tarsha Chamaine Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497244875 PECOS PAC ID: 3476800301 Enrollment ID: I20180723003146 |
| Provider Name | Takatso Moyo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952809774 PECOS PAC ID: 2769739507 Enrollment ID: I20180724004142 |
| Provider Name | Chantal Cesar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992214068 PECOS PAC ID: 6002165438 Enrollment ID: I20180819000007 |
| Provider Name | Carroll G Odem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144224957 PECOS PAC ID: 0143289249 Enrollment ID: I20180906003344 |
| Provider Name | Myrlande Cayo Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992293997 PECOS PAC ID: 8224380076 Enrollment ID: I20181006000162 |
| Provider Name | Marla Kiser Buie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275049322 PECOS PAC ID: 3274886908 Enrollment ID: I20181026001999 |
| Provider Name | Christie E Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730664582 PECOS PAC ID: 1355695057 Enrollment ID: I20181115002463 |
| Provider Name | Brooklyn Hammonds Whaley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356848733 PECOS PAC ID: 1355695982 Enrollment ID: I20181116000914 |
| Provider Name | Stephanie Sizemore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467920355 PECOS PAC ID: 5395089981 Enrollment ID: I20181210000329 |
| Provider Name | Belinda I Opara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114437704 PECOS PAC ID: 4284971375 Enrollment ID: I20190128002337 |
| Provider Name | Charlotte David |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700358140 PECOS PAC ID: 0143560664 Enrollment ID: I20190320001689 |
| Provider Name | Christen Weber |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619395506 PECOS PAC ID: 7618219502 Enrollment ID: I20190424002033 |
| Provider Name | Racheal O Sowole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356803357 PECOS PAC ID: 6305189432 Enrollment ID: I20190513002189 |
| Provider Name | Yolette Lafontant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205316395 PECOS PAC ID: 9436492568 Enrollment ID: I20190513002466 |
| Provider Name | Marvet Wint |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386036895 PECOS PAC ID: 1254664865 Enrollment ID: I20190613002902 |
| Provider Name | Melina Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003374885 PECOS PAC ID: 5698008068 Enrollment ID: I20190618000840 |
| Provider Name | Johanna Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295202323 PECOS PAC ID: 2769716786 Enrollment ID: I20190625003728 |
| Provider Name | Tamu A. Spruill Barton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164953279 PECOS PAC ID: 6002143393 Enrollment ID: I20190808003422 |
| Provider Name | Emily Elizabeth Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063053478 PECOS PAC ID: 4587096086 Enrollment ID: I20191122000068 |
| Provider Name | Faizan Shaikh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376904292 PECOS PAC ID: 6800170663 Enrollment ID: I20191228000151 |
| Provider Name | Sara Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861984759 PECOS PAC ID: 9638504327 Enrollment ID: I20200128001031 |
| Provider Name | Nathan Duffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801431333 PECOS PAC ID: 9537595228 Enrollment ID: I20200128001089 |
| Provider Name | Monique Jennifer Stage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174048474 PECOS PAC ID: 5991134389 Enrollment ID: I20200406003379 |
| Provider Name | Troy Dennis Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194146720 PECOS PAC ID: 4880025063 Enrollment ID: I20200504002888 |
| Provider Name | Kaynessa Celena Providence |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013303650 PECOS PAC ID: 0547683484 Enrollment ID: I20200709003415 |
| Provider Name | Pamela Bethel-wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013404292 PECOS PAC ID: 1850645540 Enrollment ID: I20200730002214 |
| Provider Name | Jill Robinson Danahy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053959783 PECOS PAC ID: 2365862711 Enrollment ID: I20201023001018 |
| Provider Name | Yvona W Butts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144834284 PECOS PAC ID: 8325459381 Enrollment ID: I20201123001750 |
| Provider Name | Ibijoke Olubunmi Solanke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831677582 PECOS PAC ID: 1658657549 Enrollment ID: I20201228001383 |
| Provider Name | Joan Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154785335 PECOS PAC ID: 2668763855 Enrollment ID: I20210127003264 |
| Provider Name | Victoria Oluyemi O'babatunde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881224657 PECOS PAC ID: 8022424720 Enrollment ID: I20210304000000 |
| Provider Name | Tychelle Yvette Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134648595 PECOS PAC ID: 0547527798 Enrollment ID: I20210309001991 |
| Provider Name | Lynn Marie Marsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588285639 PECOS PAC ID: 0941618912 Enrollment ID: I20210413001566 |
| Provider Name | Dana Michele Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174111892 PECOS PAC ID: 3375951957 Enrollment ID: I20210420001853 |
| Provider Name | Andrea Lynne Maloy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447845243 PECOS PAC ID: 3971912999 Enrollment ID: I20210504001320 |
| Provider Name | Vanessa Copeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548761000 PECOS PAC ID: 2466716188 Enrollment ID: I20210506001982 |
| Provider Name | Samuel Ikechukwu Ogbuchi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912403320 PECOS PAC ID: 0042610537 Enrollment ID: I20210621003384 |
| Provider Name | Heather M. Mclaughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861032187 PECOS PAC ID: 2062840812 Enrollment ID: I20210726002596 |
| Provider Name | Babatunde Madamidola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942881255 PECOS PAC ID: 0749683894 Enrollment ID: I20210727001616 |
| Provider Name | Barbara Terica Dunbar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588872253 PECOS PAC ID: 3779825708 Enrollment ID: I20210827000281 |
| Provider Name | Briana Watkins Clarke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548937618 PECOS PAC ID: 2668861204 Enrollment ID: I20211119001172 |
| Provider Name | Amy Elizabeth Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518564525 PECOS PAC ID: 9931590445 Enrollment ID: I20211216002488 |
| Provider Name | Pamela Jo Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386206126 PECOS PAC ID: 9436541737 Enrollment ID: I20220119000172 |
| Provider Name | Isi Obadan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598992208 PECOS PAC ID: 7416174248 Enrollment ID: I20220204000208 |
| Provider Name | Nathacha Lorquet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407481864 PECOS PAC ID: 5698168086 Enrollment ID: I20220208000205 |
| Provider Name | Laura Barber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417618273 PECOS PAC ID: 2365835279 Enrollment ID: I20220216001652 |
| Provider Name | Nicole L Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790393064 PECOS PAC ID: 0345634119 Enrollment ID: I20220222001429 |
| Provider Name | Gaboy Jupiter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033656715 PECOS PAC ID: 0648554758 Enrollment ID: I20220309000909 |
| Provider Name | Priti V Jindal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003850322 PECOS PAC ID: 3375592322 Enrollment ID: I20220329000694 |
| Provider Name | Etoy N Flemmings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750038659 PECOS PAC ID: 2769879022 Enrollment ID: I20220505000526 |
| Provider Name | Jacqueline Quintero |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992101075 PECOS PAC ID: 6305160508 Enrollment ID: I20220526001748 |
| Provider Name | Marrissa Lynn Bryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558964684 PECOS PAC ID: 5799163549 Enrollment ID: I20220607000826 |
| Provider Name | Guertone Sutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376138909 PECOS PAC ID: 2567841604 Enrollment ID: I20220621002706 |
| Provider Name | Nedra Heath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407514615 PECOS PAC ID: 8426439183 Enrollment ID: I20220713001610 |
| Provider Name | Latoya Venise Montfort |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528695137 PECOS PAC ID: 6800277179 Enrollment ID: I20220718002054 |
| Provider Name | Nedege Raybourne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386125516 PECOS PAC ID: 2668854480 Enrollment ID: I20220726003438 |
| Provider Name | Marie Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396470688 PECOS PAC ID: 0941683767 Enrollment ID: I20220811001952 |
| Provider Name | Nakesha Wilkes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639549868 PECOS PAC ID: 9537544135 Enrollment ID: I20220919000890 |
| Provider Name | William Patton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417670662 PECOS PAC ID: 3577949254 Enrollment ID: I20221004000516 |
| Provider Name | Sharika Tillman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154057990 PECOS PAC ID: 8729455233 Enrollment ID: I20221111001342 |
| Provider Name | Brian Lee |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1669856894 PECOS PAC ID: 7012275894 Enrollment ID: I20221222001952 |
| Provider Name | Jessica Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023639457 PECOS PAC ID: 7214307123 Enrollment ID: I20230110000496 |
| Provider Name | Susan Rollan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144938473 PECOS PAC ID: 0345610150 Enrollment ID: I20230111002188 |
| Provider Name | Ilyasah Byfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841478187 PECOS PAC ID: 3173699295 Enrollment ID: I20230125000907 |
| Provider Name | Sabiha K Kaiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760195226 PECOS PAC ID: 9234500364 Enrollment ID: I20230126003494 |
| Provider Name | Rhonda Felicia Lomax |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538651278 PECOS PAC ID: 2567834385 Enrollment ID: I20230203001869 |
| Provider Name | Brian Pawlowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578284923 PECOS PAC ID: 2365814407 Enrollment ID: I20230217001713 |
| Provider Name | Marjean Tyndale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992268908 PECOS PAC ID: 2365817574 Enrollment ID: I20230330003048 |
| Provider Name | Renita Walls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780381657 PECOS PAC ID: 2860867009 Enrollment ID: I20230331001387 |
| Provider Name | Marie Candy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548517063 PECOS PAC ID: 9931354602 Enrollment ID: I20230403001285 |
| Provider Name | Ugomma Abanukam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609580471 PECOS PAC ID: 2567827330 Enrollment ID: I20230501000215 |
| Provider Name | Lorraine Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356966717 PECOS PAC ID: 9032593777 Enrollment ID: I20230510001168 |
| Provider Name | Ajibola Babatunde |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1629573936 PECOS PAC ID: 0143570770 Enrollment ID: I20230522002010 |
| Provider Name | Sydney Anabel Colon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508551367 PECOS PAC ID: 7214394956 Enrollment ID: I20230612000911 |
| Provider Name | Adrianne Crane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891264792 PECOS PAC ID: 3870924335 Enrollment ID: I20230623002245 |
| Provider Name | Tanya Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922707025 PECOS PAC ID: 3779941547 Enrollment ID: I20230627000680 |
| Provider Name | Bolanle Olubunmi Adedokun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215510268 PECOS PAC ID: 5799148904 Enrollment ID: I20230905002905 |
| Provider Name | Sara Graves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295324895 PECOS PAC ID: 0143625111 Enrollment ID: I20230905003098 |
| Provider Name | Haika Gloria Kisamo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528741436 PECOS PAC ID: 0143684688 Enrollment ID: I20230915002612 |
| Provider Name | E'lexus Okafor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598384224 PECOS PAC ID: 0446604136 Enrollment ID: I20230928003885 |
| Provider Name | Crystal Collier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710514484 PECOS PAC ID: 0446607691 Enrollment ID: I20231108003541 |
| Provider Name | Kobena Y Waters |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699263848 PECOS PAC ID: 1052768256 Enrollment ID: I20231109001911 |
| Provider Name | Achangwo Mary Lekeaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568235661 PECOS PAC ID: 2365890712 Enrollment ID: I20231127001592 |
| Provider Name | Kendra Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346900065 PECOS PAC ID: 8325432446 Enrollment ID: I20231208002128 |
| Provider Name | Camille Lindo-wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902402118 PECOS PAC ID: 6204245434 Enrollment ID: I20240209001354 |
| Provider Name | Emilia Bazan-grow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902835275 PECOS PAC ID: 4183621311 Enrollment ID: I20240212001269 |
| Provider Name | Karen Felicia Stephens-vasser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790427631 PECOS PAC ID: 7416391842 Enrollment ID: I20240214000202 |
| Provider Name | Senelisiwe Nozipho Ncube |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457125700 PECOS PAC ID: 3678917762 Enrollment ID: I20240216001369 |
| Provider Name | Audrey Marcel Mitchell-carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205699816 PECOS PAC ID: 5294170437 Enrollment ID: I20240228000950 |
| Provider Name | Kourtney Danielle Chang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477306090 PECOS PAC ID: 2264872241 Enrollment ID: I20240425000658 |
| Provider Name | Shoshana Guttman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669249538 PECOS PAC ID: 1850835935 Enrollment ID: I20240701000343 |
| Provider Name | Marilyn Stanford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538567235 PECOS PAC ID: 5294271144 Enrollment ID: I20240726002713 |
| Provider Name | Veronica I Ohwowhiagbese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922850528 PECOS PAC ID: 3870025786 Enrollment ID: I20241016004635 |
| Provider Name | Blima Krasnow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548004914 PECOS PAC ID: 6103350590 Enrollment ID: I20241107001942 |
| Provider Name | Jemilat Azeez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700404167 PECOS PAC ID: 8921418153 Enrollment ID: I20241229000054 |
| Provider Name | Makeisha Lewis Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588214530 PECOS PAC ID: 5890222020 Enrollment ID: I20241230000005 |
Proactive Physicians Of Marietta, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 790 Church St Ne, Suite 220, Marietta, GA 30060 Phone: 678-753-9300 Fax: 678-753-9300 | |
Independent Physical Therapy Of Georgia, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1205 Johnson Ferry Rd Ste 130, Marietta, GA 30068 Phone: 770-565-3201 Fax: 770-565-3203 | |
Premise Health Of Georgia Medical, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 86 South Cobb Drive Mail Drop 0454, Marietta, GA 30063 Phone: 770-494-4131 Fax: 770-494-7490 | |
Clifford Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1355 Church Street Ext Ne Ste G, Marietta, GA 30060 Phone: 678-388-1355 Fax: 770-422-1416 | |
Saint Joseph's Mercy Care Services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1407 Cobb Parkway Nw, Marietta, GA 30060 Phone: 678-843-8600 | |
Epitome Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 631 Campbell Hill St Nw Ste 200, Marietta, GA 30060 Phone: 770-727-6124 | |
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