NPIMap

Organization Active NPI

Medcura Health, Inc.

Doing business as KIPP Woodson Park Academy School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
National Provider Identifier
1487592093
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDCURA HEALTH, INC.
Doing business as
KIPP Woodson Park Academy School Based Health Center
Practice address
1571 Donald Lee Hollowell Pkwy NW
Atlanta, GA 30318-5049
Phone
(404) 298-8998
NPI assigned
Mar 24, 2026
Last updated
Mar 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Authorized official

Name
Jeff Taylor
Title
Ceo
Phone
(404) 492-7303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1571 Donald Lee Hollowell Pkwy NW
Atlanta, GA 30318-5049

Mailing address

5582 Memorial Dr
Stone Mountain, GA 30083

Other names 1

  • KIPP Woodson Park Academy School Based Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260521002878 GA Part A Provider - Federally Qualified Health Center (FQHC) 2961443643 Practice locations: Atlanta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487592093. Details of each certification follow.

Federally qualified health center certification: CCN C21066

Legal name
MEDCURA HEALTH, INC
Doing business as
KIPP WOODSON PARK ACADEMY SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2026
Last certification
May 19, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1571 Donald Lee Hollowell Pkwy NW
Atlanta, GA 30318-5049

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2238057Medcura Health - Kipp Woodson Park1571 Donald Lee Holloway Parkway NW, Atlanta, GA 30318Certificate of waiverSep 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medcura Health Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Fallany Stover Individual Corporate DirectorBoard Member Sep 22, 2010
D'Nyce Williams Individual Corporate DirectorBoard Member Sep 22, 2010
Brian O Williams Individual Corporate DirectorBoard Member Sep 22, 2010
Christina Ottis Individual Corporate DirectorBoard Member Sep 22, 2010
Clara Cobb Individual Corporate DirectorBoard Member Sep 22, 2010
Kayla Latson Individual Corporate DirectorBoard Member Sep 22, 2010
Jeffrey Taylor Individual Corporate OfficerCeo Dec 24, 2024
W-2 Managing EmployeeCeo Dec 24, 2024
Hugo Cruz Individual Corporate DirectorBoard Member Sep 22, 2010
Michele Henson Individual Corporate DirectorBoard Member Sep 22, 2010
Daphne Bryd Individual Corporate DirectorBoard Member Sep 22, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medcura Health, IncStone Mountain, GA, CCN 111962 Federally qualified health center Operational/Managerial Control (100%)
Other (100%)		 May 9, 2005
May 9, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1774310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774396800000",
    "number": "1487592093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5582 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "30083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 DONALD LEE HOLLOWELL PKWY NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303185049",
            "telephone_number": "404-298-8998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCURA HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-24",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-492-7303"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIPP Woodson Park Academy School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.