FOUR CORNERS PRIMARY CARE CENTERS INC (NPI# 1265624548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265624548 |
| Entity Type | Organization |
| Organization Name | FOUR CORNERS PRIMARY CARE CENTERS INC |
| Other Organization Name | FOUR CORNERS @ VPH |
| Practice Address |
5300 Oakbrook Pkwy Suite 130 Norcross GA 30093-2256 |
| Practice Telephone | 7702793142 |
| Practice Fax Number | 7702345210 |
| Mailing Telephone | 7702793142 |
| Mailing Fax Number | 7702345210 |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | DR. BRIAN O. WILLIAMS (CEO) |
| Authorized Official Telephone | 7702793140 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 162765396A | 05 |
| Other Name | Type Code |
|---|---|
| Four Corners @ VPH | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548622285 | Four Corners Primary Care Centers Inc | Clinic/Center | 115 Towne Center Pkwy, Suite 113, Hoschton, GA 30548-2213 | 2016-03-22 |
| Street Address |
5300 OAKBROOK PKWY SUITE 130 |
| City | NORCROSS |
| State | GA |
| Zip Code | 30093-2256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548715113 | Teresa De Jesus Flores | Nurse Practitioner | 5300 Oakbrook Pkwy, Suite 130, Norcross, GA 30093-2256 | 2016-08-23 |
| 1841464534 | Manisha Sharma | Pediatrics | 5300 Oakbrook Pkwy, Suite 130, Norcross, GA 30093-2256 | 2008-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013517465 | Tequila Olivia Banks | Counselor | 8303 Dunleaf Arc Way Nw, Norcross, GA 30093 | 2020-10-27 |
| 1922643485 | Anthony Ervin | Case Manager/Care Coordinator | 6251 Smithpoint Dr. Bldg B, Peachtree Corners, GA 30093 | 2019-11-08 |
| 1164908885 | Marianne Altares | Speech-Language Pathologist | 1709 Oakbrook Lake Dr, Norcross, GA 30093 | 2018-07-16 |
| 1518480763 | Braces Now 14, LLC | Dentist | 4141 Steve Reynolds Blvd, Suite 2, Norcross, GA 30093 | 2017-07-19 |
| 1457802902 | Audrey Fernandes | Dentist | 4846 Jimmy Carter Blvd, Suite 203, Norcross, GA 30093 | 2016-10-19 |
| 1922456318 | Diana Lleras | Counselor | 6020 Dawson Bld Suite I, Norcross, GA 30093 | 2016-05-26 |
| 1376941500 | Katerine Velez | Counselor | 6020 Dawson Blvd., Siute I, Norcross, GA 30093 | 2014-12-22 |
| 1679979017 | Allison Ballay Donnelly | Speech-Language Pathologist | 1626 Jeurgens Ct., Norcross, GA 30093 | 2014-11-12 |
| 1588913701 | Sunrise Pharmacy | Pharmacy | 1235 Indian Trail Rd, Suite 200a, Norcross, GA 30093 | 2012-09-04 |
| 1821347154 | Shakirah Forde | Counselor | 1770 Indian Trail Lilburn Rd Ste 120, Norcross, GA 30093 | 2012-08-31 |
| Find all providers in zip 30093 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
| 1588149256 | Center for Pan Asian Community Services, Inc. | Clinic/Center | 6185 Buford Hwy Bldg A, Norcross, GA 30071-2350 | 2018-09-28 |
| 1336493311 | Center for Pan Asian Community Services, Inc. | Clinic/Center | 6185 Buford Hwy, Building G, Norcross, GA 30071-2350 | 2012-10-30 |
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| 1023658523 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1407 Cobb Parkway Nw, Marietta, GA 30060-6546 | 2020-01-13 |
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| 1417597238 | The Family Health Centers of Georgia, Inc | Clinic/Center | 19 John Maddox Dr Nw Ste B, Rome, GA 30165-1477 | 2020-01-09 |
| 1649810714 | Careconnect Health, Inc. | Clinic/Center | 254 Wright Avenue, Roberta, GA 31078 | 2020-01-07 |
| 1437798725 | Careconnect Health, Inc. | Clinic/Center | 414 S Frontage Rd Lot 53, Forsyth, GA 31029-3025 | 2020-01-03 |
| 1285277608 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1976 Flat Shoals Rd Se Ste B, Atlanta, GA 30316-2857 | 2019-10-18 |
| Find all providers with the same taxonomy | ||||
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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.