MLK Urgent Care Center

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

026238 Issued in GA

Legal business name

MLK URGENT CARE CENTER

Practice address

1276 Cedar Keys CT
Stone Mountain, GA 30083-1811

Phone

(770) 256-7033

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Beverly Idris, AAS

Title

Nurse

Phone

(770) 256-7033

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1801159298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 MLK DR SW # JR",
            "address_2": "SUITE C",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303101187",
            "telephone_number": "770-256-7033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 CEDAR KEYS CT",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300831811",
            "telephone_number": "770-256-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLK URGENT CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "IDRIS",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "NURSE",
        "authorized_official_telephone_number": "770-256-7033",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AAS"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "GA",
            "license": "026238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Minor
• Nasra Mohamed Mirreh, MSW
• Merica Mitchell, CD, CBE
• Jasheen Mizelle
• MLH Mobile Solutions LLC
• MMT Care LLC
• Mnodern Ecclesia
• Michael Moccio, D.C.
• Hassan Ali Moeti, DMD
• Selamawit Mola, FNP

• Multi-Specialty Clinic/Center in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Multi-Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.