DR. CHAD DONALD COSTLEY (NPI# 1700832011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700832011 |
| Entity Type | Individual |
| Full Name | DR. CHAD DONALD COSTLEY |
| Credential | M.D. |
| Practice Address |
402 W Ponce De Leon Ave Decatur GA 30030-2443 |
| Practice Telephone | 4043719673 |
| Practice Fax Number | 6785154653 |
| Mailing Telephone | 4045372521 |
| Mailing Fax Number | 6785154653 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2015-08-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 054263 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
402 W PONCE DE LEON AVE |
| City | DECATUR |
| State | GA |
| Zip Code | 30030-2443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922608678 | Morgan Brooke Littleton | Registered Nurse | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2020-10-30 |
| 1124584784 | Tara Noorani | Nurse Practitioner | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2019-02-19 |
| 1427324342 | Kara Nicole Brown | Nurse Practitioner | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2012-03-25 |
| 1477865681 | Ponce Primary Care LLC | Clinic/Center | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2010-07-06 |
| 1245494525 | Emily Jane Walker | Family Medicine | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2008-07-15 |
| 1689762759 | David Orozco | Dietitian, Registered | 402 W Ponce De Leon Ave, Decatur, GA 30030-2443 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413174 | Pa-c Surgical Assist, LLC | Clinic/Center | 520 W Ponce Leon Ave #1706, Decatur, GA 30030 | 2020-07-02 |
| 1417587478 | Elizabeth Heffron | Acupuncturist | 619b East College Avenue, Decatur, GA 30030 | 2020-01-17 |
| 1669016143 | Atlanta Upper Cervical Chiropractic LLC | Chiropractor | 125 E Trinity Place, Suite #247, Decatur, GA 30030 | 2019-10-29 |
| 1831757418 | Jessica Stewart | Counselor | 755 Commerce Dr Ste 903, Decatur, GA 30030 | 2019-05-30 |
| 1699238733 | Dinah Augustin | Registered Nurse | 1458 Church St., Unit B, Decatur, GA 30030 | 2019-04-06 |
| 1093284291 | Eliza Segell | Social Worker | 165 Dekalb Industrial Way Ste D-1, Decatur, GA 30030 | 2018-11-16 |
| 1912476466 | Positive Impact Health Centers, Inc. | Pharmacy | 523 Church Street, Suite B, Decatur, GA 30030 | 2018-11-14 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1992292858 | Keeanna M Powell | Counselor | Agape Transformation Practice, 235 E. Ponce De Leon Ave Suite 103, Decatur, GA 30030 | 2018-04-17 |
| 1780185488 | Solutions Ae Inc | Counselor | One West Square Court, Suite 710, Decatur, GA 30030 | 2018-02-27 |
| Find all providers in zip 30030 | ||||
| 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 |
|---|---|---|---|---|
| 1982170817 | Health-e LLC | Family Medicine | 1466 Country Squire Dr, Decatur, GA 30033-2414 | 2018-10-18 |
| 1548772536 | D'neka Colzie | Family Medicine | 2663 Easterly Pl, Decatur, GA 30035-4004 | 2017-10-30 |
| 1356862551 | Amruta Dutia | Family Medicine | 102 W Kenwood Ave Ste 102, Decatur, IL 62526-4380 | 2017-06-28 |
| 1962938043 | Atlanta Functional & Integrative Medicine | Family Medicine | 2786 N Decatur Rd, Decatur, GA 30033-5928 | 2017-05-10 |
| 1194179341 | Alexander Bryant Mcqueen | Family Medicine | 2422 Danville Rd Sw Ste E, Decatur, AL 35603-4221 | 2016-04-13 |
| 1609259969 | Vitale Medical Inc | Family Medicine | 3290 Memorial Dr Ste B1, Decatur, GA 30032-3400 | 2015-07-06 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1881036879 | Brigitte B. Nahmias | Family Medicine | 114 Mckoy St, Decatur, GA 30030-4346 | 2013-07-19 |
| 1275976094 | Zachary James Shipp | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2013-04-11 |
| 1790023497 | Philip Henry Sharkey | Family Medicine | 4666 E Powers Blvd, Decatur, IL 62521-2549 | 2013-01-30 |
| Find all providers in DECATUR | ||||
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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.