Provider Demographics
NPI:1740645464
Name:POINTE OF CARE,LLC
Entity type:Organization
Organization Name:POINTE OF CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEKESA
Authorized Official - Middle Name:MICHELL
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:404-946-0248
Mailing Address - Street 1:3379 PEACHTREE RD NE
Mailing Address - Street 2:STE. 555
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1031
Mailing Address - Country:US
Mailing Address - Phone:404-946-0248
Mailing Address - Fax:404-946-0249
Practice Address - Street 1:3379 PEACHTREE RD NE
Practice Address - Street 2:STE. 555
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1031
Practice Address - Country:US
Practice Address - Phone:404-946-0248
Practice Address - Fax:404-946-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214831261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137494Medicaid
GA202G708011OtherMEDICARE