Individual provider Active NPI

Angela East, CPNP

  • Pediatric Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1649661539
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN184825 Issued in GA
Practice address
5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807
Phone
(404) 785-6895
Fax
(404) 785-6896
NPI assigned
Feb 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN184825 GA
Pediatric Nurse Practitioner 363LP0200X RN184825 GA Primary

Addresses

Primary practice location

5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807

Mailing address

5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807
Phone (404) 785-6895

Other practice location 1

315 W Ponce De Leon Ave Ste 110
Decatur, GA 30030-2441
Phone (404) 537-2521

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

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
I20241231001678 GA Practitioner - Nurse Practitioner 5597056986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ponce Preventive Care LLCGroup PAC ID 6406987544, 10 clinicians

Practice addresses (Care Compare)

315 W Ponce de Leon Ave
Suite 110
Decatur, GA 30030-2441
Phone (404) 537-2521

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN184825GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ponce Preventive Care LLC CurrentSince Oct 21, 2024 Accepting new patients
Choa Multispecialty, LLC Pediatrics PastSince Jun 27, 2021 Accepting new patients

Locations

315 W Ponce de Leon Ave
Ste 110
Decatur, GA 30030
Phone (404) 371-9673

Interoperability endpoints

  • Direct secure messaging: angela.east.1@9773.direct.athenahealth.com

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": "1423699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1649661539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5461 MERIDIAN MARK RD STE 570",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422807",
            "telephone_number": "404-785-6895",
            "fax_number": "404-785-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5461 MERIDIAN MARK RD STE 570",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422807",
            "telephone_number": "404-785-6895",
            "fax_number": "404-785-6896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 W Ponce De Leon Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300302441",
            "country_code": "US",
            "telephone_number": "404-537-2521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EAST",
        "first_name": "ANGELA",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-12",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN184825",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN184825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "5461 Meridian Mark Rd Ste 570",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303422807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.