Geraldine Eccleston Menchion, FNP, BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN151173 Issued in GA

Practice address

175 Country Club Dr BLDG 100D
Stockbridge, GA 30281-7380

Phone

(678) 819-5497

Fax

(678) 601-1508

NPI assigned

May 27, 2022

Reactivated

Oct 3, 2022

Last updated

Jan 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Gem Primary Healthcare, LLC.

  • Primary Care Clinic/Center
  • Stockbridge, GA
  • NPI 1457072647
  Medicare reassignment NPD Authorized official
• Oasis Gives Hope Inc

  • Primary Care Clinic/Center
  • Conyers, GA
  • NPI 1801546908
  NPD (past)

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1598403628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 COUNTRY CLUB DR BLDG 100D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817380",
            "telephone_number": "404-514-6066",
            "fax_number": "678-601-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 COUNTRY CLUB DR BLDG 100D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817380",
            "telephone_number": "678-819-5497",
            "fax_number": "678-601-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENCHION",
        "first_name": "GERALDINE",
        "middle_name": "ECCLESTON",
        "credential": "FNP, BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-27",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "deactivation_date": "2022-09-07",
        "reactivation_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN151173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medicine Pointe Pharmacy LLC
• Miles Anthony Medina, D.O.
• Medsure Supplies LLC
• Liliana Mejia, DDS
• Melapop Aesthetics LLC
• Kenneth F. Menchion, MD
• Mental Health Solution to Wellness PC
• Mercy Medical Supply LLC
• Mercy's Quality Home Care, LLC
• Mercy's Quality Home Care, Llc300562457

• Family Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.