CLARKSTON PRIMARY & URGENT CARE, LLC (NPI# 1043781420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1043781420 |
Entity Type | Organization |
Organization Name | CLARKSTON PRIMARY & URGENT CARE, LLC |
Practice Address |
4600 E Ponce De Leon Ave Ste A Clarkston GA 30021-1839 |
Practice Telephone | 7707035408 |
Practice Fax Number | 8777795837 |
Mailing Telephone | 7707035408 |
Mailing Fax Number | 8777795837 |
Enumeration Date | 2018-12-11 |
Last Update Date | 2018-12-11 |
Authorized Official Name | MS. ETSUBDENKE AREAYA (AUTHORIZED OFFICIAL) |
Authorized Official Telephone | 6787632247 |
Authorized Official Credential | FNP-C |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
CLARKSTON PRIMARY & URGENT CARE LLC | Doing Business As Name - Organization |
CLARKSTON PRIMARY & URGENT CARE LLC | Former Legal Business Name - Organization |
Street Address |
4600 E PONCE DE LEON AVE STE A |
City | CLARKSTON |
State | GA |
Zip Code | 30021-1839 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659874287 | Bliss Primary and Urgent Care PC | Clinic/Center | 4600 E Ponce De Leon Ave Ste A, Clarkston, GA 30021-1839 | 2018-03-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578081808 | Marqueta A Coffer | Case Manager/Care Coordinator | 1380 Brockett Pl, Clarkston, GA 30021 | 2017-09-07 |
1063965143 | Bertukan Worku Demas | Pharmacist | 3671 Cobble Mill Ln, Clarkston, GA 30021 | 2016-07-26 |
1912341967 | Esther Kim | Family Medicine | 887 N Indian Creek Dr Ste A, Clarkston, GA 30021 | 2013-04-22 |
1265739437 | Carepoint Home Care, LLC | In Home Supportive Care | 4122 E Ponce Deleon Avenue, Unit 9, Clarkston, GA 30021 | 2011-02-23 |
1790956530 | Thu D. Vu | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
1740310630 | Gentle Dental | Dentist | 3595 Hill St., Clarkston, GA 30021 | 2007-03-07 |
1679528491 | Ojoru Osunkoya | Pediatrics | 4112 E. Ponce De Leon, Clarkston, GA 30021 | 2006-05-23 |
1700849825 | Regina Allen Hardin | Pediatrics | 4112 E. Ponce De Leon Avenue, Clarkston, GA 30021 | 2006-04-10 |
1831514538 | Caudelle & Wilson Eye Care LLC | Optometrist | 320 N Jeff Davis Drive, Suite A, Fayetteville, GA 30021 | 2014-03-04 |
1881865624 | Vanessa Phan | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
Find all providers in zip 30021 |
Taxonomy Code | 207Q00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568843142 | David William Mcnaughton | Family Medicine | 6770 Dixie Hwy Ste 303, Clarkston, MI 48346-2090 | 2015-06-09 |
1912341967 | Esther Kim | Family Medicine | 887 N Indian Creek Dr Ste A, Clarkston, GA 30021 | 2013-04-22 |
1780927251 | Mary S Crowell | Family Medicine | 1119 Highland Ave Ste 10, Clarkston, WA 99403-2836 | 2013-04-02 |
1164794251 | Kong C. Choi | Family Medicine | 8324 Caribou Trl., Clarkston, MI 48348 | 2012-02-03 |
1194040626 | Sathish Mannaickal Philip | Family Medicine | 6483 Citation Dr Ste B, Clarkston, MI 48346-2994 | 2010-03-26 |
1952504987 | Maria Livieratos Md Pllc | Family Medicine | 5799 S Main St, #1472, Clarkston, MI 48347-9907 | 2007-06-07 |
1598897530 | Dorothy A. O. White-williams | Family Medicine | 3700 Market St Ste C, Clarkston, GA 30021-2652 | 2007-03-12 |
1396881827 | Clarkston Medical Clinic PC | Family Medicine | 5790 S Main Street, Ste J, Clarkston, MI 48346 | 2007-01-30 |
1427155985 | Comprehensive Medical Care | Family Medicine | 5710 Bella Rose Blvd, Suite 200, Clarkston, MI 48348-4773 | 2006-09-19 |
1437178720 | Fabrizio Di Noto | Family Medicine | 6483 Citation Drive, Suite B, Clarkston, MI 48346 | 2006-07-18 |
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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.