NPI: 1043609134

SOUTHERN GRACE HEALTHCARE

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• Entity Type: Organization
• Last Observed in the System¹ on:
• First Entered in the System¹ on: 2015-01-13
• Medicare Revalidation Due Date²: Not Available
• Certified the records on: Not Certified
• NPPES Profile Page: https://npiregistry.cms.hhs.gov/provider-view/1043609134
• CMS Profile Page: https://data.cms.gov/tools/medicare-physician-other-practitioner-look-up-tool/provider/1043609134

Addresses

• Primary & Current, 364 RACETRACK RD, MCDONOUGH, GA 302521022

Taxonomies

• 2018-01-07 ~ Present ³ , Internal Medicine Physician (207R00000X), Primary
• 2018-01-07 ~ Present ³ , In Home Supportive Care Agency (253Z00000X), Other

Licenses

• 2018-01-07 ~ Present ³ , 64068, GA

Orgs. with the Same Mailing Address (5)

The list below shows the Organization Entities (Entity Type Code: 2) with the same mailing addresses. They may be other branch offices or co-located businesses.

• SOUTHERN GRACE HOSPICE AND PALLIATIVE CARE (1124448188)
• SERENITY CLINIC, LLC (1083985543)
• RONALD D PATRICK MD LLC (1053649608)
• COUNSELING FOR HOPE AND HEALING, LLC (1932541166)
• CAPSTONE QUALITY CARE (1275292716)

Orgs. with the Same Practice Address (9)

The list below shows the Organization Entities (Entity Type Code: 2) with the same practice addresses. They may be co-located businesses.

• WEIGHT LOSS AND VITALITY CENTER LLC (1932969334)
• VITALITY HEALTH PRIMARY CARE LLC (1649011842)
• SERENITY CLINIC, LLC (1083985543)
• RONALD D PATRICK MD LLC (1053649608)
• MODERN PODIATRY, LLC (1811538390)
• MICHELLE KLOS D.C. INC. (1760717573)
• MCDONOUGH INTERNAL MEDICINE (1609907559)
• COUNSELING FOR HOPE AND HEALING, LLC (1932541166)
• CAPSTONE QUALITY CARE (1275292716)

Notes

1. https://nppes.cms.hhs.gov/#/
2. https://data.cms.gov/tools/medicare-revalidation-list
3. Our records go back to 2018-01-07, and any records preceding this date are not captured. Please regard 2018-01-07 as the earliest date we could verify the records back then, not as the actual date for the time range.
4. https://openpaymentsdata.cms.gov/
5. The information is based on the UnitedHealthcare Transparency in Coverage site.