HERITAGE MEDICAL GROUP, PC (NPI# 1356526305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356526305 |
| Entity Type | Organization |
| Organization Name | HERITAGE MEDICAL GROUP, PC |
| Practice Address |
1010 Pennsylvania Avenue Heritage Medical Group, PC Mcdonough GA 30253 |
| Practice Telephone | 7702883883 |
| Practice Fax Number | 7702883885 |
| Mailing Telephone | 7702883883 |
| Mailing Fax Number | 7702883885 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |
| Authorized Official Name | DR. OLADAYO ADISA OSINUGA (MEDICAL DIRECTOR/OWNER) |
| Authorized Official Telephone | 7702883883 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 057161 | GA | Allopathic & Osteopathic Physicians |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN178172NP | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207R00000X | Internal Medicine | 51703 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | BO7921340 | 01 |
| Street Address |
1010 PENNSYLVANIA AVENUE HERITAGE MEDICAL GROUP, PC |
| City | MCDONOUGH |
| State | GA |
| Zip Code | 30253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565159 | First Choice Home Health Care LLC | In Home Supportive Care | 600 Westridge Parkway, Suite 707, Mcdonough, GA 30253 | 2020-10-15 |
| 1164033783 | Tanequa S Dorsey | Counselor | 40 Macon Street, Suite D, Mcdonough, GA 30253 | 2020-08-17 |
| 1396369195 | Ikponmwosa Obakpolor | Physical Therapist | 234 Village Drive, Mcdonough, GA 30253 | 2020-06-08 |
| 1205392305 | Healthstat Onsite Clinic-henry County | Preventive Medicine | 141 Henry Parkway, Healthstat Clinic, Mcdonough, GA 30253 | 2019-02-13 |
| 1588128557 | Vernette R Mathurin | Licensed Practical Nurse | 97 Atl Street Suite 100, Mcdonough, GA 30253 | 2019-01-24 |
| 1083196836 | Peta-gaye C Pilote | Registered Nurse | 319 Regal Way E, Mcdonough, GA 30253 | 2018-08-29 |
| 1275021586 | Heritage Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 155 Westridge Pkwy Ste 217, Mcdonough, GA 30253 | 2018-04-23 |
| 1457853236 | Sherrille Greene | Counselor | 609 Autumn Leaf Circle, Mcdonough, GA 30253 | 2018-03-07 |
| 1376052696 | Kendra Oreggio | Private Vehicle | 117 Janney Circle, Mcdonough, GA 30253 | 2017-09-29 |
| 1245758788 | Pamela Hobbs | Home Health Aide | 5011 Monarch Dr, Mcdonough, GA 30253 | 2017-09-05 |
| Find all providers in zip 30253 | ||||
| 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.