Anisa B Threlkeld, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

38988 Issued in GA

Practice address

980 Johnson Fy Rd NE
Suite 550
Atlanta, GA 30342-1626

Phone

(404) 631-6440

Fax

(404) 631-6332

NPI assigned

Aug 10, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1316949365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 JOHNSON FY RD NE",
            "address_2": "SUITE 550",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421626",
            "telephone_number": "404-631-6440",
            "fax_number": "404-631-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 JOHNSON FY RD NE",
            "address_2": "SUITE 550",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421626",
            "telephone_number": "404-631-6440",
            "fax_number": "404-631-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THRELKELD",
        "first_name": "ANISA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "38988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000619077",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Lyall Threatt, DNP, AGACNP-BC
• Three C, LLC
• Three Hills Medical Solutions LLC
• Three Points Acupuncture
• Threee Nutrition, LLC
• Woodfin Jackson Threlkeld Jr., LCSW
• Thrive Anesthesia LLC
• Thrive Bright ABA Ga LLC
• Thrive Now Nutrition LLC
• Thrive Orthopaedics ASC LLC

• Ophthalmology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Ophthalmology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.