LOTUS FAMILY WELLNESS CLINIC, LLC (NPI# 1013497171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013497171 |
| Entity Type | Organization |
| Organization Name | LOTUS FAMILY WELLNESS CLINIC, LLC |
| Practice Address |
1240 Highway 138 Sw Riverdale GA 30296-1402 |
| Mailing Address |
280 Bonnie Ln Fayetteville GA 30215-8802 |
| Practice Telephone | 4046681827 |
| Mailing Telephone | 4046681827 |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |
| Authorized Official Name | QIANA AIDAH JOHNSON (OWNER/FAMILY NURSE PRACTITIONER) |
| Authorized Official Telephone | 4046681827 |
| Authorized Official Credential | DNP, FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003151631F | 05 |
| Street Address |
1240 HIGHWAY 138 SW |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30296-1402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043629363 | Qiana A Johnson | Nurse Practitioner | 1240 Highway 138 Sw, Riverdale, GA 30296-1402 | 2014-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558594 | James D Hickman | Home Health Aide | 2252 Addison Park, Riverdale, GA 30296 | 2020-11-04 |
| 1255973251 | Octavia Bostic | Nurse's Aide | 7670 Creekside Lane, Riverdale, GA 30296 | 2019-10-10 |
| 1548746829 | Verna Stoner-frazier | Physical Therapist | 1542 Bethaven Rd, Riverdale, GA 30296 | 2018-07-19 |
| 1346762705 | Letty Searcy | Case Manager/Care Coordinator | 7125 E. Village Ct, Riverdale, GA 30296 | 2017-07-07 |
| 1225402639 | Optima Physical Therapy Services | Clinic/Center | 808 Commerce Boulevard, Riverdale, GA 30296 | 2015-11-23 |
| 1437409224 | Mobile Nursing Service LLC | Nursing Care | 829 Scott Rd, Riverdale, GA 30296 | 2012-09-19 |
| 1104069517 | Taina S. Holly | Licensed Practical Nurse | 1234 Elgin Way, Riverdale, GA 30296 | 2009-04-15 |
| 1386720118 | Absolute Healthcare & Rehab Center | Chiropractor | 1807 Hwy 138 Sw, Riverdale, GA 30296 | 2006-10-27 |
| 1467558650 | Daniel Tesfa Redie | Dentist | 1849 Hwy 138, Riverdale, GA 30296 | 2006-09-15 |
| 1033214184 | Malcolm Hill | Chiropractor | 1296 Hwy 138, Suite 105, Riverdale, GA 30296 | 2006-09-13 |
| Find all providers in zip 30296 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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|---|---|---|---|---|
| 1164940672 | Primecare Medical Center | Clinic/Center | 86 Upper Riverdale Rd Sw Ste 201, Riverdale, GA 30274-2614 | 2017-09-05 |
| 1659774644 | Rediclinic of Md, LLC | Clinic/Center | 6130 Baltimore Avenue, Riverdale, MD 20737-1905 | 2014-10-03 |
| 1588818330 | Neu Life Chiropractic | Clinic/Center | 6511 Church St, Riverdale, GA 30274-2106 | 2008-11-06 |
| 1427175090 | Southside Medical Center, Inc. | Clinic/Center | 116 Upper Riverdale Rd Sw, Riverdale, GA 30274 | 2007-03-26 |
| 1629159066 | Clayton W Straughn Md Pa | Clinic/Center | 4404 Queensbury Rd Ste 130, Riverdale, MD 20737-1068 | 2006-10-18 |
| 1073028536 | Okeh Health Group, LLC | Clinic/Center | 33 Upper Riverdale Rd Sw, 17, Riverdale, GA 30274 | 2017-12-06 |
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| 1558981985 | Elite Mens' Health, LLC | Clinic/Center | 3361 Nottinghill Ln, Valdosta, GA 31605-5874 | 2020-04-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.