NPIMap

Organization Active NPI

Inner Community Health

  • Psychiatry Physician
  • Duluth, GA
National Provider Identifier
1891398541
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INNER COMMUNITY HEALTH
Practice address
2180 Satellite Blvd Ste 400
Duluth, GA 30097-4927
Phone
(800) 620-6950
Fax
(877) 290-0408
NPI assigned
Nov 17, 2020
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Mirica Sanders, DONPI 1336466820
Title
Owner
Phone
(216) 577-3441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

2180 Satellite Blvd Ste 400
Duluth, GA 30097-4927

Mailing address

2180 Satellite Blvd Ste 400
Duluth, GA 30097-4927

Other practice location 1

223 Medical Center Dr
Riverdale, GA 30274-2640
Phone (800) 620-6950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230823000046 GA Part B Supplier - Clinic/Group Practice 8729441852 Receives reassigned benefits from 17 practitioners
Practice locations: Duluth, GA; Riverdale, GA

National Provider Directory

National Provider Directory

Locations

10700 Medlock Bridge Rd
Ste 104
Johns Creek, GA 30097
Phone (770) 476-9885

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1891398541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 SATELLITE BLVD STE 400",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 SATELLITE BLVD STE 400",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974927",
            "telephone_number": "800-620-6950",
            "fax_number": "877-290-0408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "223 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302742640",
            "country_code": "US",
            "telephone_number": "800-620-6950",
            "fax_number": "877-290-0408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNER COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "MIRICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-577-3441",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.