Provider Demographics
NPI:1346911294
Name:DESTINY HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DESTINY HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:OYERINDE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:678-761-5287
Mailing Address - Street 1:4742 LANTERN CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7545
Mailing Address - Country:US
Mailing Address - Phone:678-761-5287
Mailing Address - Fax:
Practice Address - Street 1:4742 LANTERN CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-7545
Practice Address - Country:US
Practice Address - Phone:678-761-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty