Grenada Adult Healthcare Clinic PC.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

20373 Issued in MS

Legal business name

GRENADA ADULT HEALTHCARE CLINIC PC.

Doing business as

Grenada Adult HealthCare Clinic PC.

Practice address

965 J K Avent Dr
Suite 106
Grenada, MS 38901-5045

Phone

(662) 227-6450

Fax

(662) 227-6452

NPI assigned

Aug 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Justice Aaron Gondwe, M.D.NPI 1912928086

Title

President

Phone

(662) 227-6450

Specialties & licenses 2

Addresses

Other names 1

• Grenada Adult HealthCare Clinic PC. Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21585/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Justice Aaron Gondwe, M.D.

  • Infectious Disease Physician
  • Grenada, MS
  • NPI 1912928086
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1144478512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 J K AVENT DR",
            "address_2": "SUITE 106",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015045",
            "telephone_number": "662-227-6450",
            "fax_number": "662-227-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 J K AVENT DR",
            "address_2": "SUITE 106",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015045",
            "telephone_number": "662-227-6450",
            "fax_number": "662-227-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA ADULT HEALTHCARE CLINIC PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "GONDWE",
        "authorized_official_first_name": "JUSTICE",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-227-6450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MS",
            "license": "20373",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "20373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grenada Adult HealthCare Clinic PC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Goss Mental Health and Wellness PLLC
• Jennifer Lee Goss, FNP
• Grace Health & Rehab of Grenada, LLC
• Grancare, LLC
• Grandcare
• Grenada Anesthesiology Inc.
• Grenada Cardiology LLC
• Grenada Clinic for Women, PA
• Grenada Dental Associates
• Grenada Dental Clinic PLLC

• Primary Care Clinic/Center in Grenada, MS
• Providers in Grenada, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; 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.