Executive Medical Healthcare Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042544 Issued in GA

Legal business name

EXECUTIVE MEDICAL HEALTHCARE SERVICES

Practice address

990 Bear Creek Blvd
Suite G
Hampton, GA 30228-1864

Phone

(678) 479-1234

Fax

(678) 479-5678

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jelunder Clark, M.D.

Title

Medical Director, Family Practice

Phone

(678) 479-1234

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Wellness Medicine Doing business as

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1992826705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 224",
            "city": "LOVEJOY",
            "state": "GA",
            "postal_code": "302500224",
            "telephone_number": "678-479-1234",
            "fax_number": "678-479-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 BEAR CREEK BLVD",
            "address_2": "SUITE G",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302281864",
            "telephone_number": "678-479-1234",
            "fax_number": "678-479-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JELUNDER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR, FAMILY PRACTICE",
        "authorized_official_telephone_number": "678-479-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "042544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D1014694",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250161583A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "042544",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ernia Nechelle Era, HEALTH CARE OWNER
• Nadine Ergas-Kitchens
• Estella Transport LLC.
• Yvette Wright Etheridge
• Excel Physical Therapy Inc
• Express Care LLC
• Eye Can See
• Eye Can See Eyewear Inc.
• Family Leadership Serivces Inc
• Deidra C. Favors, FNP

• Family Medicine Physician in Hampton, GA
• Providers in Hampton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.