Active NPI
Consuela Dickerson-Whitfield
- Health Service Clinic/Center
- Stone Mountain, GA
National Provider Identifier
1891675849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Clinic/Center
- License
- 2993387
- Practice address
- 5385 Five Forks Trickum Rd Ste N
Stone Mountain, GA 30087-3018 - Phone
- (470) 610-9299
- NPI assigned
- Sep 2, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | 2993387 | GA | Primary |
Addresses
Primary practice location
5385 Five Forks Trickum Rd Ste N
Stone Mountain, GA 30087-3018
Mailing address
5385 Five Forks Trickum Rd Ste N
Stone Mountain, GA 30087-3018
Phone (470) 610-9299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2993387 | GA | MD | Health Service Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756771200000",
"number": "1891675849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5385 FIVE FORKS TRICKUM RD STE N",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300873018",
"telephone_number": "470-610-9299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5385 FIVE FORKS TRICKUM RD STE N",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300873018",
"telephone_number": "470-610-9299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON-WHITFIELD",
"first_name": "CONSUELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-09-02",
"last_updated": "2025-09-02",
"certification_date": "2025-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": "GA",
"license": "2993387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
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- Betty Dillon, DDS
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.