Provider Demographics
NPI:1225621311
Name:MERIDIAN EDUCATION RESOURCE GROUP, INC
Entity Type:Organization
Organization Name:MERIDIAN EDUCATION RESOURCE GROUP, INC
Other - Org Name:WHITEFOORD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:TINDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-693-7565
Mailing Address - Street 1:1353 GEORGE W BRUMLEY WAY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1743
Mailing Address - Country:US
Mailing Address - Phone:404-373-6614
Mailing Address - Fax:
Practice Address - Street 1:35 WHITEFOORD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1727
Practice Address - Country:US
Practice Address - Phone:404-588-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA918809059AMedicaid