Vistas Medical Center,PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

GA038149 Issued in GA

Legal business name

VISTAS MEDICAL CENTER,PC

Practice address

5329 Memorial Dr Ste a
Stone Mountain, GEORGIA 30083
UM

Phone

(404) 296-7695

Fax

(404) 296-7696

NPI assigned

Feb 3, 2009

Organization subpart

No

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

Authorized official

Name

Nicholas Kemdi Ihenacho, MD

Title

MD/Ceo

Phone

(404) 296-7695

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chidi D Ikeokwu, NP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1730653619
  NPD (past)
• Adeliene G Isaac David

  • Adult Health Nurse Practitioner
  • Stone Mountain, GA
  • NPI 1457682809
  NPD (past)
• Nnenna Beatrice Otaluka, NP

  • Family Nurse Practitioner
  • Stone Mountain, GA
  • NPI 1730604620
  NPD (past)

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1104064815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870828",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300870027",
            "telephone_number": "404-296-7695",
            "fax_number": "404-296-7696"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "5329 MEMORIAL DR STE A",
            "city": "STONE MOUNTAIN",
            "state": "GEORGIA",
            "postal_code": "30083",
            "telephone_number": "404-296-7695",
            "fax_number": "404-296-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTAS MEDICAL CENTER,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "IHENACHO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "KEMDI",
        "authorized_official_title_or_position": "MD/CEO",
        "authorized_official_telephone_number": "404-296-7695",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "GA038149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000727108D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "321313",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.