Individual provider Active NPI

Candace Moon Banes, FNP-C

  • Primary Care Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1447847298
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN232068 Issued in GA
Practice address
424 Decatur St SE
Atlanta, GA 30312-1848
Phone
(678) 843-8600
NPI assigned
Dec 28, 2020
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN232068 GA Primary

Addresses

Primary practice location

424 Decatur St SE
Atlanta, GA 30312-1848

Mailing address

424 Decatur St SE
Atlanta, GA 30312-1848
Phone (678) 843-8600

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
I20210413000223 GA Practitioner - Nurse Practitioner 9931517976 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

3350 Breckinridge Blvd
Suite 200
Duluth, GA 30096-4959
Phone (770) 962-8396

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Positive Impact Health Centers Inc CurrentSince Jun 1, 2025 Accepting new patients
Positive Impact Health Centers, Inc. CurrentSince Jun 1, 2025 Accepting new patients

Locations

3075 Breckinridge Blvd
Ste 415
Duluth, GA 30096
Phone (770) 962-8396

3350 Breckinridge Blvd
Ste 200
Duluth, GA 30096
Phone (770) 962-8396

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/6123adb2-d0d2-485a-9dcf-5fba87efb2ef/

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1447847298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "678-843-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "678-843-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANES",
        "first_name": "CANDACE",
        "middle_name": "MOON",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-28",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN232068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.