NPIMap

Individual provider Active NPI

Latoya S. Etheridge, M.D.

  • Family Medicine Physician
  • Malden, MA
National Provider Identifier
1972762821
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
249317 Issued in MA
Practice address
178 Savin St Ste 100
Hallmark Health Medical Associates Inc.
Malden, MA 02148-3591
Phone
(781) 338-7400
Fax
(781) 338-7405
NPI assigned
Jun 5, 2008
Last updated
May 2, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 237282 MA
Family Medicine Physician 207Q00000X 249317 MA Primary

Addresses

Primary practice location

178 Savin St Ste 100
Hallmark Health Medical Associates Inc.
Malden, MA 02148-3591

Mailing address

178 Savin St Ste 100
Hallmark Health Medical Associates Inc.
Malden, MA 02148-3591
Phone (781) 338-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160106000690 GA Practitioner - Family Practice 2466625843 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Boston University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

12460 Crabapple Rd
Suite 901
Alpharetta, GA 30004-6392
Phone (678) 762-0574

2450 Old Milton Pkwy
Alpharetta, GA 30009-2520

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
249317MAMDFamily Medicine Physician
237282MAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jan 25, 2016 Accepting new patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
North Georgia Internal Medicine, PC CurrentSince Jan 13, 2024 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jan 25, 2016 Accepting new patients
Hallmark Health Medical Associates Inc Family Medicine PastSince Jul 17, 2015 Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

3747 Roswell Rd
Ste 107
Marietta, GA 30062
Phone (470) 956-0150

1192 Buckhead Xing
Ste E
Woodstock, GA 30189
Phone (678) 494-4450

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20065/brand/1/csg/1/fhir/r4
  • Direct secure messaging: latoya.etheridge.1@20065.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1972762821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 SAVIN ST STE 100",
            "address_2": "HALLMARK HEALTH MEDICAL ASSOCIATES INC.",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021483591",
            "telephone_number": "781-338-7400",
            "fax_number": "781-338-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 SAVIN ST STE 100",
            "address_2": "HALLMARK HEALTH MEDICAL ASSOCIATES INC.",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021483591",
            "telephone_number": "781-338-7400",
            "fax_number": "781-338-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "LATOYA",
        "middle_name": "S.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "237282",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "249317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malden, MA

Sources for this page

Verify at the official NPI Registry.