Healthcare Provider Details

I. General information

NPI: 1427911924
Provider Name (Legal Business Name): YOUR WAY MEDICAL HEALTH CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 ROBERTS DR STE A-4
RIVERDALE GA
30274-2959
US

IV. Provider business mailing address

653 ROBERTS DR STE A-4
RIVERDALE GA
30274-2959
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-2099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAISY KING-GODINEAUX
Title or Position: PRESIDENT
Credential: FNP
Phone: 813-997-2099