Southern Crescent Family Practice, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

044158 Issued in GA

Legal business name

SOUTHERN CRESCENT FAMILY PRACTICE, LLC

Practice address

525 Forest Pkwy
Suite 100
Forest Park, GA 30297-2149

Phone

(678) 705-0100

Fax

(678) 235-1800

NPI assigned

Feb 8, 2008

Last updated

May 15, 2008By 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. Faith A Andrews, MDNPI 1558430280

Title

Owner

Phone

(678) 705-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 4

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.

• Faith Adonis Andrews, MD

  • Family Medicine Physician
  • Forest Park, GA
  • NPI 1558430280
  Medicare reassignment NPD Authorized official
• Evelyn Adio

  • Nurse Practitioner
  • Johns Creek, GA
  • NPI 1902342397
  NPD
• Arlene Santiago

  • Family Nurse Practitioner
  • Morrow, GA
  • NPI 1548817208
  NPD (past)
• Anya Wiedenbeck, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Forest Park, GA
  • NPI 1417657800
  NPD (past)

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1396923538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 FOREST PKWY",
            "address_2": "SUITE 100",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972149",
            "telephone_number": "678-705-0100",
            "fax_number": "678-235-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 FOREST PKWY",
            "address_2": "SUITE 100",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972149",
            "telephone_number": "678-705-0100",
            "fax_number": "678-235-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-705-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "044158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "555253916A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Courtney Latasha Steele, CCC-SLP

• Family Medicine Physician in Forest Park, GA
• Providers in Forest Park, 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 May 15, 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.