SOUTHERN GRACE HEALTHCARE (NPI# 1043609134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043609134 |
| Entity Type | Organization |
| Organization Name | SOUTHERN GRACE HEALTHCARE |
| Practice Address |
364 Racetrack Rd Mcdonough GA 30252-1022 |
| Practice Telephone | 6784328811 |
| Practice Fax Number | 6784328821 |
| Mailing Telephone | 6784328811 |
| Mailing Fax Number | 6784328821 |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |
| Authorized Official Name | AUBREY KEKIWI (CEO) |
| Authorized Official Telephone | 6784328811 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 253Z00000X | In Home Supportive Care | Agencies | ||
| Y | 207R00000X | Internal Medicine | 64068 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
364 RACETRACK RD |
| City | MCDONOUGH |
| State | GA |
| Zip Code | 30252-1022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073114427 | Publix Super Markets, Inc | Durable Medical Equipment & Medical Supplies | 3479 Highway 81 East, Mcdonough, GA 30252 | 2020-11-03 |
| 1770143547 | Kevin Kirk Anderson | Physical Therapist | Dr. Kevin Anderson, 196 Lake Dow Rd, Mcdonough, GA 30252 | 2019-06-14 |
| 1912474537 | Atlanta Neuromonitoring, LLC | Psychiatry & Neurology | 922 Highway 81 East # 242, Mcdonough, GA 30252 | 2018-11-01 |
| 1194271320 | Christine Williams Breeden | Registered Nurse | 189 Irwin Drive, Mcdonough, GA 30252 | 2016-08-28 |
| 1518322395 | Jaquita Shorts | Counselor | 1705 Pennslyvania Ave, Mcdonough, GA 30252 | 2015-12-22 |
| 1356758973 | Keisha Candies | Counselor | 125 Zack Hinton Pkwy, Mcdonough, GA 30252 | 2014-07-15 |
| 1093145666 | Ceisha Shador Parks | Counselor | 6040 Winston Trace, Mcdonough, GA 30252 | 2013-11-19 |
| 1588939565 | Tasha E Jones | Counselor | 1509 Bent River Cir, Mcdonough, GA 30252 | 2012-03-09 |
| 1598049447 | Proactive Rehab, Inc | Physical Therapist | 50 Lawrenceville Street, Suite 100, Mcdonough, GA 30252 | 2011-10-10 |
| 1164706131 | Michelle Lee Cone | Pharmacist | 1210 Bent Creek Dr, Mcdonough, GA 30252 | 2011-10-07 |
| Find all providers in zip 30252 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053584508 | Priceless Primary Health Care of Atlanta Inc | Internal Medicine | 119 Griffin St, Suite 100b, Mcdonough, GA 30253-3123 | 2008-04-04 |
| 1609907559 | Mcdonough Internal Medicine | Internal Medicine | 382 Racetrack Road, Mcdonough, GA 30252 | 2007-03-09 |
| 1104932607 | Willie F Rainey | Internal Medicine | 1125 Towne Centre Village, Henry Towne Centre Medical Center, Mcdonough, GA 30253 | 2006-08-21 |
| 1962492744 | Carrie L Madej | Internal Medicine | 917 Jonesboro Road, Mcdonough, GA 30253-6031 | 2005-10-24 |
| 1275523045 | Andrea R Miles | Internal Medicine | 101 Regency Park Dr, Suite 150, Mcdonough, GA 30253-7080 | 2005-10-24 |
| 1033111349 | Poonam Ramani | Internal Medicine | 374 Racetrack Rd, Mcdonough, GA 30252-1022 | 2005-06-01 |
| 1215321971 | Adam Anglyn | Internal Medicine | 55 Sims St, Mcdonough, GA 30253-2320 | 2015-03-20 |
| 1013209733 | Phoenix Medical Group of Ga LLC | Internal Medicine | 917 Jonesboro Road, Mcdonough, GA 30253-6031 | 2011-05-13 |
| 1053602045 | Tse-hwa Johnson Yin | Internal Medicine | 2200 Highway 155 N, Mcdonough, GA 30252-4846 | 2011-04-25 |
| 1992933576 | Todd Jason Meadows | Internal Medicine | 1125 Towne Centre Village Drive, Kaiser Permanente Henry Towne Centre Medical Center, Mcdonough, GA 30253 | 2009-06-23 |
| Find all providers in MCDONOUGH | ||||
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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.