Grace Medical Practice LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

001305 Issued in GA

Legal business name

GRACE MEDICAL PRACTICE LTD

Practice address

1136 Cleveland Ave Ste 309
East Point, GA 30344-3618

Phone

(404) 763-1240

Fax

(404) 393-6524

NPI assigned

Oct 2, 2009

Last updated

Oct 2, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Fidelia O Osinubi, MDNPI 1013194661

Title

Ceo

Phone

(404) 861-0291

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Grace Medical Practice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Grace Medical Practice LLC

  • Primary Care Clinic/Center
  • Atlanta, GA
  • NPI 1407186877
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fidelia O Osinubi, MD

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1013194661
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254441600000",
    "number": "1396070744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20156",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303250156",
            "telephone_number": "404-861-0291",
            "fax_number": "404-393-6524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 CLEVELAND AVE STE 309",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443618",
            "telephone_number": "404-763-1240",
            "fax_number": "404-393-6524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEDICAL PRACTICE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-02",
        "last_updated": "2009-10-02",
        "status": "A",
        "authorized_official_last_name": "OSINUBI",
        "authorized_official_first_name": "FIDELIA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-861-0291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "001305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "778620923A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BIRTH DATE",
            "identifier": "06/11/1956",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethel U Godwins
• Vinaya Gokki, MD
• Gold Star Transportation Services, LLC
• Golden Standard Care Partners
• Yalanda Lavette Golphin, LCC
• Grady Memorial Hospital Corporation (East Point Grady Health Center Pharmacy)
• Grady Memorial Hospital Corporation (Grady Delivery Pharmacy)
• Gray Matters Counseling and Consulting Associates LLC
• Kiya Green-Dixie, DDS, MS
• Brielle Morgan Griffis

• Family Medicine Physician in East Point, GA
• Providers in East Point, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; 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.