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VISTAS MEDICAL CENTER,PC
NPI 1104064815
Clinic/Center - Medical Specialty in Stone Mountain, GEORGIA

Active since February 03, 2009
5329 MEMORIAL DR STE A, STONE MOUNTAIN, GEORGIA 30083(404) 296-7695(404) 296-7696 Get Directions Write a Review

NPPES record last updated: October 21, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Vistas Medical Center,pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VISTAS MEDICAL CENTER,PC (NPI 1104064815) is a healthcare organization registered as a medical specialty in Stone Mountain, GEORGIA and active in the NPI registry since February 2009. The organization lists Nicholas Kemdi Ihenacho, Md/ceo, as its authorized official.

NPPES Registry Identity

NPI1104064815
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameVISTAS MEDICAL CENTER,PC
Location Address5329 MEMORIAL DR STE AStone Mountain, GEORGIA 30083
Mailing AddressPo Box 870828Stone Mountain, GA 30087-0027 · (404) 296-7695 · Fax (404) 296-7696
Phone(404) 296-7695
Fax(404) 296-7696
Organization SubpartNo
Authorized OfficialNicholas Kemdi IhenachoMd/ceo · (404) 296-7695
Enumeration DateFebruary 3, 2009
Last NPPES UpdateOctober 21, 2011
✔ NPI 1104064815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in GA · GA038149
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
5329 MEMORIAL DR STE A, Stone Mountain, GEORGIA 30083
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Other Identifiers 3

Medicare UPIN11BDVGXGA
Medicaid000727108DGA
Other321313GA · Wellcare

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NNENNA BEATRICE OTALUKA NP
Nurse Practitioner (Family)
5329 MEMORIAL DR STE A
STONE MOUNTAIN, GA 30083
Dekalb County (404) 296-7695
VISTAS HOME CARE, INC.
Respite Care
5329 MEMORIAL DR STE A
STONE MOUNTAIN, GA 30083
Dekalb County (678) 904-7050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vistas Medical Center,pc's NPI number?

The NPI number for Vistas Medical Center,pc is 1104064815. It was assigned to this organization in the NPPES registry on February 3, 2009.

Where is Vistas Medical Center,pc located?

Vistas Medical Center,pc is located at 5329 Memorial Dr Ste A, Stone Mountain, GEORGIA 30083. The listed phone number is (404) 296-7695.

What is Vistas Medical Center,pc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Vistas Medical Center,pc was last updated on October 21, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.