Individual provider Active NPI

Ceretha Thomas, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • McDonough, GA
National Provider Identifier
1124061791
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
211903 Issued in GA
Practice address
139 Henry Pkwy
McDonough, GA 30253
Phone
(770) 358-5252
NPI assigned
Jun 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 211903NP GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 211903 GA Primary

Addresses

Primary practice location

139 Henry Pkwy
McDonough, GA 30253

Mailing address

1464 Indian Forest CT
Stone Mountain, GA 30083-5436
Phone (404) 740-2870

Other practice location 1

1779 Stanton Rd SW
Atlanta, GA 30311-4108
Phone (850) 339-3245

Other identifiers 1

IdentifierTypeStateIssuer
003104504GMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130725000876 GA Practitioner - Nurse Practitioner 1951482900 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grady Memorial Hospital CorporationGroup PAC ID 7517032998, 365 clinicians

Practice addresses (Care Compare)

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3050
Phone (404) 616-8880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Arts, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
211903NPGAMDFamily Nurse Practitioner
211903GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grady Memorial Hospital Corporation CurrentSince Jan 1, 2024 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince Jan 1, 2024 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

80 Jesse Hill Jr Dr SE
#26019
Atlanta, GA 30303
Phone (404) 616-2219

7741 Roswell Rd
Sandy Springs, GA 30350
Phone (404) 612-2273

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1124061791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 INDIAN FOREST CT",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300835436",
            "telephone_number": "404-740-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 HENRY PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "30253",
            "telephone_number": "770-358-5252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1779 Stanton Rd SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303114108",
            "country_code": "US",
            "telephone_number": "850-339-3245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "CERETHA",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "211903NP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "211903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003104504G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

Verify at the official NPI Registry.