Centerwell Senior Primary Care Ga PC
Organization Active NPI Internal Medicine Physician · Atlanta, GA
NPI 1043887698 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1043887698
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE GA PC
- Practice address
- 3571 Martin Luther King Jr Dr SW
Atlanta, GA 30331-4017 - Phone
- (470) 832-6550
- Fax
- (877) 887-6103
- NPI assigned
- Jun 10, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE GA PC
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Specialist
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 12
Corporate family (same tax ID) 12
Practitioners 4
-
Meredith Banks, FNP-C
-
Joseph Fowlkes, MD
-
Camille Antoinette Lindo-Wilson, MSN FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210901004313 | GA | Part B Supplier - Clinic/Group Practice | 3274939061 |
Receives reassigned benefits from 69 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Atlanta, GA; Woodstock, GA; Suwanee, GA; Stone Mountain, GA; South Fulton, GA; Savannah, GA; Morrow, GA; Marietta, GA… |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care Ga PC
- Part of
- Centerwell Senior Primary Care Ga PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
3571 Martin Luther King Jr Dr SW
Atlanta, GA 30331-4017
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000
Other names
- CenterWell Senior Primary Care-Adamsville
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- Centiva Homecare, Inc.
- Melissa Centofante
- Central Medical Group, Inc.
- Central Transport
All providers in Atlanta, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.