Theramed Health, LLC
Organization Active NPI Family Medicine Physician · Kennesaw, GA
NPI 1487056586 · NPPES record last updated Jul 15, 2020
Key facts
- NPI
- 1487056586
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- THERAMED HEALTH, LLC
- Practice address
- 3440 Blue Springs Rd NW Ste 503
Kennesaw, GA 30144-1038 - Phone
- (404) 857-9575
- Fax
- (888) 857-4685
- NPI assigned
- Sep 19, 2014
- Organization subpart
- No
Authorized official
- Name
- Nicole Reed
- Title
- Chief Executive Officer
- Phone
- (404) 857-9575
Practitioners 20
-
Jasmine Nicole Bass, FNP-C
-
Malinda Rochelle Conrad, FNP-BC
-
Antonia Maisha Harris, FNP-C
-
Erika Kang, FNP-C, PMHNP-BC
-
Charles Timothy Riney, PSY.D.
-
Chantalette Tysheria Smith, MSN, APRN, FNP-C
-
Alisha Nicole Thomas, FNP-C
-
Marisa Virostek, AGNP-C
-
Christina Susanne Johnson, FNP-C
-
Elizabeth L Watson, FNP-C
-
Samantha Pruitt, PMHNP-BC, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150121001157 | GA | Part B Supplier - Clinic/Group Practice | 0345564472 |
Receives reassigned benefits from 19 practitioners Practice locations: Kennesaw, GA |
National Provider Directory
Locations
3950 Cobb Pkwy NW
Ste 401
Acworth, GA 30101
Phone (404) 857-9575
3440 Blue Springs Rd NW
Ste 503
Kennesaw, GA 30144
Phone (404) 513-5053
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | |||
| Counseling Psychologist |
103TC1900X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Sports Medicine (Family Medicine) Physician |
207QS0010X |
Addresses
Primary practice location
3440 Blue Springs Rd NW Ste 503
Kennesaw, GA 30144-1038
Mailing address
3440 Blue Springs Rd NW Ste 503
Kennesaw, GA 30144-1038
Phone (404) 857-9575
Other providers in Kennesaw, GA
- The Pediatric Therapy Clinic, Inc.
- The Perfect Arch LLC
- The River of Life Chiropractic Center Inc
- The River of Life Chiropractic Center Inc
- The Wellpath Center P.C.
- Thomas Eye Group PC
- Antonia Kirksey Thomas
- Cathy Hillis Thomas
- Julian Thomas
- Phallon Thomas
All providers in Kennesaw, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.