MEMORIAL HEALTH PARTNERS FOUNDATION, INC. (NPI# 1669861530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669861530 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HEALTH PARTNERS FOUNDATION, INC. |
| Other Organization Name | PROFESSIONAL PARK ASSOCIATES |
| Practice Address |
611 E Villanow St La Fayette GA 30728-2618 |
| Practice Telephone | 7066381606 |
| Practice Fax Number | 7066389987 |
| Mailing Telephone | 7066381606 |
| Mailing Fax Number | 7066389987 |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |
| Authorized Official Name | RAMON FIGUEROA (DIRECTOR PHYSICIAN OPERATIONS) |
| Authorized Official Telephone | 4234241551 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEMORIAL HEALTH PARTNERS FOUNDATION, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| Professional Park Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144633397 | Memorial Health Partners Foundation, Inc. | Clinic/Center | 645 Paul Huff Pkwy Nw, Suite 105, Cleveland, TN 37312-3149 | 2014-06-05 |
| 1760632780 | Memorial Health Partners Foundation, Inc. | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2008-09-26 |
| 1467602482 | Memorial Health Partners Foundation, Inc. | Family Medicine | 6401 Mountain View Rd, Suite 109, Ooltewah, TN 37363-6681 | 2008-09-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEMORIAL HEALTH PARTNERS FOUNDATION, INC | 5600 Brainerd Rd Ste 500, Chattanooga, TN 37411-5371 |
| Street Address |
611 E VILLANOW ST |
| City | LA FAYETTE |
| State | GA |
| Zip Code | 30728-2618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336132679 | Eric J Betts | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2005-08-23 |
| 1255976726 | Jessica Rose Nowlin | Nurse Practitioner | 611 E Villanow St, La Fayette, GA 30728-2618 | 2019-11-08 |
| 1780152421 | Aubry Lynn Knight | Nurse Practitioner | 611 E Villanow St, La Fayette, GA 30728-2618 | 2018-11-12 |
| 1861977381 | Diana Morrison | Nurse Practitioner | 611 E Villanow St, La Fayette, GA 30728-2618 | 2018-10-01 |
| 1568910461 | Emily Elswick | Physician Assistant | 611 E Villanow St, La Fayette, GA 30728-2618 | 2016-09-20 |
| 1760632780 | Memorial Health Partners Foundation, Inc. | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2008-09-26 |
| 1376520874 | Richard C Smith | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2005-12-27 |
| 1275510851 | Teddy A Scoggins | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2005-12-27 |
| 1346225919 | Suzanne Storey | Family Medicine | 611 E Villanow St, La Fayette, GA 30728-2618 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395620 | Primary Health Care Center of Dade, Inc. | Clinic/Center | 8a Probasco Street Unit 214, Lafayette, GA 30728 | 2020-10-30 |
| 1891358750 | K -va -t Food Stores Inc | Durable Medical Equipment & Medical Supplies | 311 North Main Street, Lafayette, GA 30728 | 2019-04-17 |
| 1023505914 | Heather Staton | Pharmacist | 324 W. Patton Street, Lafayette, GA 30728 | 2018-04-17 |
| 1023484805 | Tyler Kellum Levie | Dentist | 201 E. Villanow Street, Lafayette, GA 30728 | 2015-08-17 |
| 1083987481 | Krishawna Elaine Montgomery | Counselor | 501 Mize Street Lookout Mountain Community Services, Lafayette, GA 30728 | 2012-02-15 |
| 1346518198 | William Randall Smith | Behavioral Analyst | 902 Daugherty Street, Lafayette, GA 30728 | 2011-12-08 |
| 1821321506 | John H Rockwell | Contractor | 143 Golden Oaks Dr, La Fayette, GA 30728 | 2009-09-11 |
| 1619113057 | Lookout Mountain Community Services | Community/Behavioral Health | 43 Shady Court, Lafayette, GA 30728 | 2009-01-06 |
| 1326212705 | Lookout Mountain Community Services | Community/Behavioral Health | 1218 Chattanooga St., Lafayette, GA 30728 | 2008-04-17 |
| 1649444084 | Lookout Mountain Community Services | Community/Behavioral Health | 29 Mae Tucker Rd., Lafayette, GA 30728 | 2008-04-16 |
| Find all providers in zip 30728 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740823202 | Gwinnett Pulmonary Group Duluth | Non-Pharmacy Dispensing Site | 3855 Pleasant Hill Rd Ste 180, Duluth, GA 30096-8093 | 2019-10-28 |
| 1063061315 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 1280 Dogwood Dr Se, Conyers, GA 30013-5046 | 2019-09-10 |
| 1659929339 | Ankle and Foot Centers of Georgia, LLC | Non-Pharmacy Dispensing Site | 1975 Highway 54 W Ste 200, Peachtree City, GA 30269-4794 | 2019-08-27 |
| 1801444591 | Ankle and Foot Centers of Georgia, LLC | Non-Pharmacy Dispensing Site | 2326 Highway 34 E Ste 200, Newnan, GA 30265-1328 | 2019-08-27 |
| 1225686991 | Ankle and Foot Centers of Georgia, LLC | Non-Pharmacy Dispensing Site | 1819 Peachtree Rd Ne Ste 103, Atlanta, GA 30309-1848 | 2019-08-27 |
| 1265995724 | Georgia Urology Pa | Non-Pharmacy Dispensing Site | 5900 Hillandale Dr Ste 200, Lithonia, GA 30058-3858 | 2019-04-11 |
| 1861980955 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 4763 Atlanta Hwy Ste 420, Loganville, GA 30052-6788 | 2018-04-25 |
| 1184111338 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 10945 State Bridge Rd Ste 901, Alpharetta, GA 30022-8164 | 2018-04-13 |
| 1538666854 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 1575 Mount Vernon Rd, Dunwoody, GA 30338-4146 | 2018-04-12 |
| 1811494156 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 6063 Peachtree Pkwy Ste 210a, Peachtree Corners, GA 30092-3303 | 2018-04-12 |
| Find all providers with the same taxonomy | ||||
| City | LA FAYETTE |
| Zip Code | 30728 |
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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.