Healthcare Provider Details

I. General information

NPI: 1659030427
Provider Name (Legal Business Name): DESTINY HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 LANTERN CT. LITHONIA GA 30038 4742 LANTERN COURT
LITHONIA GA
30038
US

IV. Provider business mailing address

4742 LANTERN CT. LITHONIA GA 30038 4742 LANTERN COURT
LITHONIA GA
30038
US

V. Phone/Fax

Practice location:
  • Phone: 470-574-6589
  • Fax:
Mailing address:
  • Phone: 470-574-6589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MERCY OYERINDE
Title or Position: NP
Credential:
Phone: 470-574-6589