Provider Demographics
NPI:1417011487
Name:MEDCURA HEALTH, INC.
Entity Type:Organization
Organization Name:MEDCURA HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-298-8998
Mailing Address - Street 1:5582 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3215
Mailing Address - Country:US
Mailing Address - Phone:404-298-8998
Mailing Address - Fax:404-298-7658
Practice Address - Street 1:5582 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3215
Practice Address - Country:US
Practice Address - Phone:404-298-8998
Practice Address - Fax:404-298-7658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKHURST MEDICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000446388AMedicaid
GAGRP603Medicare PIN
GA111962Medicare Oscar/Certification