Clarkston Primary & Urgent Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CLARKSTON PRIMARY & URGENT CARE, LLC

Practice address

4600 E Ponce de Leon Ave Ste a
Clarkston, GA 30021-1839

Phone

(770) 703-5408

Fax

(877) 779-5837

NPI assigned

Dec 11, 2018

Last updated

Dec 11, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Etsubdenke Areaya, FNP-C

Title

Authorized Official

Phone

(678) 763-2247

Specialties & licenses 1

Addresses

Other names 1

• CLARKSTON PRIMARY & URGENT CARE LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mandana Rezaei-Amiri, M.D.

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1518923879
  Medicare reassignment NPD
• Lilian Ayidi Vende

  • Family Nurse Practitioner
  • Clarkston, GA
  • NPI 1225886609
  Medicare reassignment NPD
• Fariba Sohrabi, DNP

  • Family Nurse Practitioner
  • Clarkston, GA
  • NPI 1871427641
  NPD
• Selamawit Mola, FNP

  • Family Nurse Practitioner
  • Stone Mountain, GA
  • NPI 1619673944
  NPD (past)
• Elizabeth Sam

  • Primary Care Nurse Practitioner
  • Lilburn, GA
  • NPI 1154828366
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544486400000",
    "number": "1043781420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 E PONCE DE LEON AVE STE A",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211839",
            "telephone_number": "770-703-5408",
            "fax_number": "877-779-5837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 E PONCE DE LEON AVE STE A",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211839",
            "telephone_number": "770-703-5408",
            "fax_number": "877-779-5837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON PRIMARY & URGENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-11",
        "last_updated": "2018-12-11",
        "status": "A",
        "authorized_official_last_name": "AREAYA",
        "authorized_official_first_name": "ETSUBDENKE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "678-763-2247",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLARKSTON PRIMARY & URGENT CARE LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CLARKSTON PRIMARY & URGENT CARE LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Huei-Chen Cheng, LPC
• Mariya George Cheriyampurathu
• Patrice Gibson Chishom, MD
• Clarkston Community Health Center, Inc.
• Clarkston Family Medicine
• Marqueta A Coffer
• Corinthianhomwcareservices (HomeCareServices)
• Kimberley Anne Crawford, PHD, MPH, RN, FNP-C
• Casey C Cudmore, RBT
• Emily Howell Curia, NP

• Family Medicine Physician in Clarkston, GA
• Providers in Clarkston, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.