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Fulton County Department of Health & Wellness
Nutr
Terry Grandison
Phone: 404- 612-1211
99 Jesse Hill Jr. Drive Suite 409-A
Atlanta GA 30303
Agency Email:
Expiration Date: 2024-06-30
Sent to Facility: 2016-03-10
Sent to Provost: 2016-03-15
Sent to Legal:
Completed: 2021-05-26
Requester Name: Jessica Todd
Document 1: Fulton County Contract
Document 2: Fulton Board of Health County
Document 3:
Comment: Fulton County Board of Health same as FC dept of Health and Wellness Renewal sent, resent 4/25/14; forwarded concerns to OLA for review;Caroline reached out to Attorney Terry Grandison for negoiation of MOU 5/20/15.Routed to Legal to Legal Affairs for Provost signature 3/11/16. Sent to facility for signature 3/17/16. Sent follow up 11/8/16. Jessica todd initiating renewal on 12/10/2020. Not sure if this MOU is different as it was initiated by Caroline Lombard 3 years ago. My POC for precepting is: Danica Carswell, MS, RD, LD, CLC WIC Nutrition Manager Fulton County Board of Health Oak Hill Child, Adolescent, & Family Center 2805 Metropolitan Pkwy SW, Atlanta, GA 30315 404-612-6750• Fax: 404-612-1598• Cell: 404-324-6443 danica.carswell@fultoncountyga.gov

 
Laurel Heights
Byrdine F Lewis School of Nursing and Health Professions
Cheryl Wright
Phone: 404-888-7865
934 Briarcliff Road
Atlanta GA 30306
Agency Email: Cheryl.Wright@uhsinc.com
Expiration Date: 2023-01-31
Sent to Facility: 2020-01-21
Sent to Provost: 2019-12-19
Sent to Legal: 2019-08-17
Completed: 2020-02-10
Requester Name: Lisa Williams
Document 1: Laurel Height MOU
Document 2:
Document 3:
Comment: 8/17 - template to Caroline and Kelli. LYW 10/17/19 Facility returned with more edits. To c. lombard for review. 12/18/19 Edits approved. to Provost for signature 1/21/20 to facility for final signature

 
AG Rhodes Health and Rehab - Wesley Woods
Department of Physical Therapy
Tammy Luther
Phone: 678-234-4949
1819 Clifton Road
Atlanta GA 30329
Agency Email: tluther@agrhodes.org
Expiration Date: 2019-01-31
Sent to Facility: 2018-11-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: renewal sent 11/27/18

 
One Family Pediatrics
BFLCNHP
Hiral Lavania
Phone: 678-962-7337
2575 Peachtree Parkway Suite 301
Cumming GA 30041
Agency Email: hlavania@onefamilypeds.com
Expiration Date: 2025-04-30
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed: 2022-04-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Cobb Community Service Board
Byrdine F Lewis School of Nursing and Health Professions
Foster Norman
Phone: 770-429-5000
3830 South Cobb Drive Suite 300
Smyrna GA 30080
Agency Email: ijlittle@cobbcsb.com
Expiration Date:
Sent to Facility: 2019-08-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
ABC Pediatrics
BFLCNHP
Tracey Blander
Phone: 770-461-4126
735 Glynn St.
Fayetteville GA 30214
Agency Email: abcpeds@bellsouth.net
Expiration Date: 2024-05-31
Sent to Facility: 2020-03-31
Sent to Provost:
Sent to Legal:
Completed: 2021-05-25
Requester Name: Lisa Williams
Document 1: ABC Pediatrics
Document 2:
Document 3:

 
Academic Clinics
School of Nursing
David T Derrer
Phone: 770-319-0037
1266 W Paces Ferry Road, NW Suite 410
Atlanta GA 30327
Agency Email:
Expiration Date: 2012-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: JoAnn Bacon
Document 1: view
Document 2:
Document 3:

 
ActiveKidz & Adult Therapy Services
Department of Physical Therapy and Occupational Therapy
Susan Cook
Phone: 706-338-8058
1071 Thomas Drive
Watkinsville GA 30677
Agency Email: activekidz2001@gmail.com
Expiration Date: 2024-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-07-07
Requester Name: Carla Huggins
Document 1: Original Expired Oct 2018
Document 2: Renewal Expires October 2021
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
Acute Care Clinic
School of Nursing
Geoff Conner
Phone: 912-537-9488
1607 Meadows Lane
Vidalia GA 30436
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:

 
Pickens County School District
Department of Occupational Therapy
Sandy Layman
Phone: 706 253 1700 ext 412
100 DB Carroll Street
Jasper Ga 30143
Agency Email: sandylayman@pickenscountyschools.org
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-07
Sent to Provost: 2017-12-07
Sent to Legal:
Completed: 2017-12-18
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: complete

 
All About Kids Therapy Services, Inc.
CNHP
Amie Locicero
Phone: 404-580-1528
545 Old Norcross Road Suite 100
Lawrenceville GA 30046
Agency Email: amie_locicero@aakts.com
Expiration Date: 2023-01-31
Sent to Facility:
Sent to Provost: 2020-02-19
Sent to Legal:
Completed: 2020-02-25
Requester Name: Carla Huggins
Document 1: AllAboutKids ExpAug2020.pdf
Document 2: Exp Jan 2023 All About Kids Theraphy.pdf
Document 3:

 
Alpha Health & Rehab
Department of Physical Therapy
James Hill
Phone: 864-879-1370
401 Chandler Road
Greer SC 29651
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-06-24
Requester Name: Jennifer Clined
Document 1:
Document 2:
Document 3:

 
Alpharetta Pediatrics
BFLCNHP
Sandy Farrell
Phone: 770.664.4430
1100 Northmeadow Pkwy Suite 108
Roswell GA 30076
Agency Email: alphapeds@yahoo.com.
Expiration Date: 2023-05-31
Sent to Facility: 2020-06-03
Sent to Provost: 2020-06-03
Sent to Legal:
Completed: 2020-08-10
Requester Name: Lisa Williams
Document 1: ExpMay2023 AlpharettaPeds for Provost signed pdf
Document 2:
Document 3:

 
Alternative Back Care Physical Therapy
Department of Physical Therapy
Christopher Ford
Phone: 253-564-2220
3502 South 12th Street Suite B
Tacoma WA 98405
Agency Email: achieve@abcphysicaltherapy.com
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-07
Requester Name: Carla Huggins
Document 1: Alternative Back Care_exp3-31-2024
Document 2:
Document 3:

 
American Diabetes Association
Department of Nutrition
Carole Helms
Phone: 404-320-7100, x 3097
275 Peachtree Street NE Suite 550
Atlanta GA 30303
Agency Email:
Expiration Date: 2014-07-31
Sent to Facility: 2011-06-13
Sent to Provost: 2011-06-17
Sent to Legal:
Completed: 2011-07-06
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Anchor Health & Rehab
Department of Physical Therapy
Robby Bowles
Phone: 803-643-3694
550 East Gate Drive
Aiken SC 29803
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal: test
Completed: 2011-06-07
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
AnMed Health
Department of Physical Therapy
Kaitlyn Hargus
Phone: 864-512-1196
800 North Fant Street Rehabilitation Services Department
Anderson SC 29621-9983
Agency Email: Beth.Pettit@anmedhealth.org
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-23
Requester Name: Carla Huggins
Document 1: AnMed_exp 03_31_2024
Document 2:
Document 3:

 
Apex Behavioral Associates, LLC
School of Nursing
Kingsley E Iyamu
Phone: 770-438-1030
1850 Lake Park Drive Suite 218
Smyrna GA 30080
Agency Email: kiyamu@bellsouth.net
Expiration Date:
Sent to Facility: 2014-11-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:

 
Appalachian Nurse Practitioner Clinic
School of Nursing
Carolyn DeSandre
Phone: 706-867-2713
82 College Circle HNS Building, Room 102
Dahlonega GA 30533
Agency Email:
Expiration Date: 2013-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Archdiocese of Atlanta - Office of Catholic Schools
School of Nursing
Diane Starkovich
Phone: 404-920-7700
Archdiocese of Atlanta 2401 Lake park Drive, SE
Smyrna GA 30080
Agency Email: DStarkovich@archatl.com
Expiration Date: 2017-06-30
Sent to Facility: 2014-06-06
Sent to Provost: 2014-06-16
Sent to Legal:
Completed: 2014-06-26
Requester Name: JoAnn Bacon
Document 1:
Document 2:
Document 3:

 
Athens Healthcare for Women
School of Nursing
Joshua Sepsi
Phone: 706-552-1600
1270 Prince Avenue Suite 308
Athens GA 30606
Agency Email:
Expiration Date: 2012-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Keiser
Document 1: view
Document 2:
Document 3:

 
Piedmont Athens Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Kelley Claas
Phone: 706-475-4569
1199 Prince Avenue
Athens GA 30606-2793
Agency Email: Kelley.claas@piedmont.org
Expiration Date: 2019-03-21
Sent to Facility: 2019-03-05
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: kclaas@armc.org undeliverable 3/2/19 3/5/19 sent to new email: Kelley.claas@piedmont.org

 
Atlanta Botanical Garden
Department of Nutrition
Kathyrn Musada
Phone: 404-591-1541
1345 Piedmont Avenue, NE
Atlanta GA 30309
Agency Email: kmasuda@atlantabotanicalgarden.org
Expiration Date: 2022-03-31
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-14
Sent to Legal:
Completed: 2019-03-29
Requester Name: Jessica Todd
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: nonclinical agreement

 
Primary Pediatrics
School of Nursing
Celeste Haines
Phone: 770-288-2285
110 Regency Park Drive
McDonough GA 30253
Agency Email: none@none.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: mou emailed

 
Atlanta Gynecology and Obstetrics, PC
BFLCNHP
Felicia Gentry
Phone: 404-299-9724
315 Winn Way
Decatur GA 30030-2111
Agency Email: f.gentry@atlantagynob.com
Expiration Date: 2024-07-31
Sent to Facility: 2018-05-31
Sent to Provost: 2018-06-01
Sent to Legal:
Completed: 2021-08-20
Requester Name: Lisa Williams
Document 1: Atlanta Gynecology and Obstetrics, PC
Document 2:
Document 3:

 
Atlanta Heart Specialists
Byrdine F Lewis School of Nursing and Health Professions
Fatima Spark
Phone: 770-638-1411
1468 Montreal Road
Tucker GA 30084
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:

 
Atlanta Independent School System
Department of Nutrition
Marilyn Hughes
Phone: 404-802-1599
130 Trinity Avenue, SW
Atlanta GA 30303-3624
Agency Email: mhhughes@atlantapublicschools.us
Expiration Date: 2020-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: This needs to be restarted. It expired.

 
Decatur Cooperative Ministry
School of Nursing
Marlene White
Phone: 404-377-5365
PO Box 457
Decatur GA 30031-0457
Agency Email: marlene@decaturcooperativeministry.org
Expiration Date: 2019-07-31
Sent to Facility: 2016-07-15
Sent to Provost: 2016-07-19
Sent to Legal:
Completed: 2016-08-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Atlanta Pain Center
School of Nursing
Kevin Knight
Phone: 404-257-1101
6255 Barfield Road Suite 155
Atlanta GA 30328
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Hewell
Document 1: view
Document 2:
Document 3:

 
Atlanta Regional Commission
Department of Nutrition
Amanda Pavery Brown
Phone: 404-463-3225
40 Courtland Street, NE
Atlanta GA 30303
Agency Email:
Expiration Date: 2016-06-30
Sent to Facility: 2013-05-09
Sent to Provost: 2013-05-16
Sent to Legal:
Completed: 2013-05-24
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Atlanta Rehabilitation and Performance Center
Department of Physical Therapy
Blythe Barrett Nicholson
Phone: 404-294-7211
2801 N Decatur Road Suite 230
Decatur GA 30033
Agency Email: bbarrett@atlantarehab.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-03
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:

 
Nutrifit Sport Therapy
Department of Nutrition
Page Love
Phone: 770.395.7331
6111 Peachtree Dunwoody Rd Building 8, Suite C
Atlanta Ga 30341
Agency Email: pagelove@nutrifitga.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-25
Requester Name: jessica todd
Document 1: Nutrifit Sport Therapy
Document 2:
Document 3:

 
Atlanta Sport & Spine Physical Therapy
Department of Physical Therapy
Danny Navarro
Phone: 404-419-7760
857 Collier Road Suite 1
Atlanta GA 30318
Agency Email: danny@atlantasportandspine.com
Expiration Date: 2022-10-31
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-17
Sent to Legal:
Completed: 2019-10-31
Requester Name: Carla Huggins
Document 1: Final Expires October 2022 1130905
Document 2:
Document 3:

 
Atlanta VA Medical Center-NS BSN
School of Nursing
Wilma C West
Phone: 404-321-6111 x7445
Education Support Service Line (141) 1670 Clairmont Road
Decatur GA 30033
Agency Email: wilma.west@va.gov
Expiration Date: N/A
Sent to Facility: 2013-10-15
Sent to Provost: 2013-10-22
Sent to Legal:
Completed: 2014-01-23
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: BSN-No Expiration Date, may be terminatinated 6 months in advance of next training experience.

 
Atlanta VA Medical Center-MS Adult
School of Nursing
Wilma C West
Phone: 404 321-6111 x7445
Education Support Service Line (141) 1670 Clairmont Road
Decatur GA 30033
Agency Email:
Expiration Date:
Sent to Facility: 2013-10-15
Sent to Provost: 2013-10-22
Sent to Legal:
Completed: 2014-01-23
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: NURSING, MS, ADULT HEALTH-No Expiration Date, may be terminatinated 6 months in advance of next training experience.

 
Atlanta VA Medical Center-DPT
Department of Physical Therapy
Archie Brown
Phone: 404-321-6111, ext. 123784
1670 Clairmont Road
Decatur GA 30033
Agency Email: Archie.Brown@va.gov
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 2/6/2020 Mr Brown sending new agreement to update terms and reset expiration date to 10 year term.

 
Atlanta West Womens Center
School of Nursing
Jaswant S Chaddha
Phone: 770-920-9745
8697 Hospital Drive Suite 201
Douglasville GA 30134-2263
Agency Email:
Expiration Date: 2013-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sybert
Document 1: view
Document 2:
Document 3:

 
Atlanta Birth Center
School of Nursing
Samantha Brooks
Phone: 404-474-2770
1 Baltimore Place, NW 105
Atlanta GA 30308
Agency Email: info@atlantabirthcenter.org
Expiration Date: 2020-08-31
Sent to Facility: 2017-08-22
Sent to Provost: 2017-09-26
Sent to Legal:
Completed: 2017-10-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 4/28/2020 - this site is only available to CNW (certified nurse midwife) students.

 
Auburn Primary Care
School of Nursing
Stephanie Anderson
Phone: 770-848-9320
12 Seventh Street
Auburn GA 30011
Agency Email:
Expiration Date: 2017-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covered under the NGPG Agreement

 
OBGYN Partners of Augusta
School of Nursing
Kelly Norman
Phone: 706-722-1381
1348 Walton Way Suite 4100
Augusta GA 30901
Agency Email: dnelms@obgynaugusta.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-14
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
Avita Community Partners
BFLCNHP
Mary Donna McAvoy
Phone: 678-960-2704
4331 Thurmon Tanner Pkwy
Flowery Branch GA 30542
Agency Email: mary.mcavoy@avitapartners.org
Expiration Date: 2023-07-31
Sent to Facility: 2020-04-29
Sent to Provost: 2020-06-08
Sent to Legal:
Completed: 2020-08-10
Requester Name: Lisa Williams
Document 1: ExpJul2023 AvitaCommPartners Apr2020 signed
Document 2:
Document 3:

 
Advance Rehabilitation for Kids of Gordon Co.
Department of Occupational Therapy
Mai Lee Payne
Phone: 706-624-3000
365 S. Industrial Blvd.
Calhoun Ga 30701
Agency Email: mailee@advanceforkids.org
Expiration Date: 2023-10-31
Sent to Facility: 2020-09-02
Sent to Provost: 2020-09-03
Sent to Legal:
Completed: 2020-11-10
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
Comment:

 
Baylor Institute for Rehabilitation
Department of Physical Therapy
Joyce Vaughn
Phone: 214-820-9376
909 North Washington Suite 105
Dallas TX 75246
Agency Email:
Expiration Date: 2014-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Beaufort Memorial Hospital
Department of Physical Therapy
Laurie Martin
Phone: 843-522-5119
955 Ribaut Road
Beaufort SC 29902-5454
Agency Email: lmartin@bmhsc.org
Expiration Date: 2018-03-31
Sent to Facility: 2015-01-13
Sent to Provost: 2015-03-10
Sent to Legal:
Completed: 2015-03-26
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Does not wish to renew contract with GSU !!

 
Behavioral Health Services of South Georgia
School of Nursing
David Sofferin
Phone: 229-671-6100
3120 North Oak Street Extension
Valdosta GA 31602-1007
Agency Email: dsofferin@bhsga
Expiration Date: 2017-06-30
Sent to Facility: 2014-06-06
Sent to Provost: 2014-06-20
Sent to Legal:
Completed: 2014-07-09
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
BenchMark Rehabilitation Partners LLC
Department of Occupational Therapy
Ashlee Jones
Phone: 4232388901
8823 Production Lane
Ooltewah TN 37363
Agency Email: ashleejones@urpt.com
Expiration Date: 2019-10-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-06-03
Sent to Legal: 2019-05-28
Completed: 2019-06-12
Requester Name: Jennifer Nelson
Document 1: Final Expires October 2022
Document 2:
Document 3:
Comment: Please make sure it covers all GA sites.

 
Bethesda Physiocare
Department of Physical Therapy
Jan Dommerholt
Phone: 301-656-5613
7830 Old Georgetown Road Suite C-15
Bethesda MD 20814-2440
Agency Email:
Expiration Date: 2011-12-31
Sent to Facility: 2012-08-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Bi-County Gwinnett Pediatrics, PC
School of Nursing
Evelyn Perez
Phone: 770-923-6400
976 Killian Hill Road Building A, Suite B
Lilburn GA 30047
Agency Email:
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-31
Sent to Provost: 2014-02-07
Sent to Legal:
Completed: 2014-03-06
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Fresenius Medical Care Holdings, Inc.
Department of Nutrition
Shilpi Ghosal
Phone: 630-960-6887
100 Galleria Parkway Suite 500
Atlanta GA 30339
Agency Email: Shilpi.Ghosal@fmc-na.com
Expiration Date: auto renews
Sent to Facility: 2020-04-03
Sent to Provost: 2020-04-10
Sent to Legal: 2020-03-12
Completed:
Requester Name: Jessica Todd
Document 1: Final Auto Renews
Document 2:
Document 3:
Comment: 4/3/20 To facility with Lombard changes 8/31/20 followed up with Kisha

 
Birmingham Physical Therapy & Sports Medicine
Department of Physical Therapy
Ellen Hamilton
Phone: 205-298-9101
3234 Cahaba Heights Road Vestavia Hills AL 35243
Agency Email:
Expiration Date: 2012-04-30
Sent to Facility: 2011-11-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
Bon Secours Family Care Center
School of Nursing
Anthony Joseph
Phone: 410-362-4481
1940 W Baltimore Street
Baltimore MD 21223-2245
Agency Email:
Expiration Date: 2012-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Gebhardt
Document 1: view
Document 2:
Document 3:

 
Dr. Brian Levitt, MD, LLC
School of Nursing
Brian Levitt
Phone: 678-904-7210
1700 Tree Lane Suite 200
Snellville GA 30078
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Hewell
Document 1: view
Document 2:
Document 3:

 
Briarcliff Oaks and Clairmont Oaks
BFLCNHP
Martin Andrew Landrum
Phone: 404-634-3263
2982 Briarcliff Road, NE
Atlanta GA 30329-2586
Agency Email: alandrum@clairmontoaks.org
Expiration Date: 2024-06-30
Sent to Facility: 2018-05-31
Sent to Provost: 2018-06-04
Sent to Legal:
Completed: 2021-07-20
Requester Name: Lisa Williams
Document 1: Briarcliff Oaks and Clairmont Oaks
Document 2:
Document 3:
Comment: Clinical Placement Contact email address: alandrum@clairmontoaks.org 5/31/18 Renewal MOU emailed - 6/4/18 sent to legal 6/22/18 Complete. Emailed to all parties

 
Brookville Hospital
Department of Physical Therapy
Joe Sansom
Phone: 814-849-2312
100 Hospital Road Rehabilitation Medicine Center
Brookville PA 15825
Agency Email:
Expiration Date: 2012-01-31
Sent to Facility: 2012-09-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Camp Kudzu-NT
Department of Nutrition
Carrie Claiborne
Phone: 404-250-1811, x27
5885 Glenridge Drive Suite 160
Atlanta GA 30328
Agency Email: cclaiborne@campkudzu.org
Expiration Date: 2024-02-29
Sent to Facility: 2017-10-17
Sent to Provost:
Sent to Legal:
Completed: 2021-03-10
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Candler County Hospital
Byrdine F Lewis School of Nursing and Health Professions
Bridget Dixon
Phone: 912-685-3213
P O Box 597
Metter GA 30439
Agency Email: bdixon@candlercountyhospital.com
Expiration Date: 2019-04-30
Sent to Facility: 2019-02-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy Masiki Williamson on communication at ptclinicaleducation@gsu.edu. Thank you.

 
Wylde Center, LLC
Department of Nutrition
Stephanie Van Parys
Phone: 6786424977
435 Oakview Rd
Decatur Ga 30030
Agency Email: stephanie@wyldecenter.org
Expiration Date: 2022-10-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-28
Sent to Legal:
Completed: 2019-10-30
Requester Name: Jessica Todd
Document 1: Exp Oct 2022 doc03516320191030160920
Document 2:
Document 3:
Comment: Non Clinical Contract

 
Carrollton Manor
Department of Nutrition
Kristen Rooks
Phone: 770-834-1737
2455 Oak Grove Church Road
Carrollton GA 30177
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility: 2011-01-28
Sent to Provost: 2011-02-01
Sent to Legal:
Completed: 2011-02-15
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Cartersville Medical Center
Occupational Therapy
Justin Laferty
Phone: 678-535-6862
960 Joe Frank Harris Parkway PO Box 200008
Cartersville GA 30120
Agency Email: Justin.Laferty@hcahealthcare.com
Expiration Date: 2022-10-21
Sent to Facility: 2018-07-09
Sent to Provost: 2018-10-15
Sent to Legal:
Completed: 2018-10-22
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Covered under Tristar Health see attached.

 
Center For Black Womens Wellness Inc.
BFLCNHP
Crissy Dorsey
Phone: 404-688-9202
477 Windsor Street, SW Suite 309
Atlanta GA 30312
Agency Email: areid@cbww.org
Expiration Date: 2024-03-31
Sent to Facility: 2018-02-14
Sent to Provost: 2018-03-22
Sent to Legal:
Completed: 2018-04-05
Requester Name: Lisa Williams
Document 1: Center For Black Womens Wellness Inc.
Document 2:
Document 3:
Comment:

 
Center for Torture and Trauma Survivors
Department of Nutrition
Roene Zohler
Phone: 770-222-6622, x 109
127 Enterprise Path Suite 405
Hiram GA 30141
Agency Email:
Expiration Date: 2013-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Cathrine McCarroll
Document 1:
Document 2:
Document 3:
Comment: 1/4/11-executed copy sent to this address returned for second time

 
Center for Womens Health and Fitness
School of Nursing
Peter Johnson
Phone: 706-369-1200
965 Hawthorne Park Suite 100-A
Athens GA 30606
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Hewell
Document 1: view
Document 2:
Document 3:

 
Center of Hope for Cancer and Blood Disorders
School of Nursing
R Brian Edwards
Phone: 770-629-2337
PO Box 1710
Stockbridge GA 30281
Agency Email:
Expiration Date: 2013-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sybert
Document 1: view
Document 2:
Document 3:

 
Central State Hospital
School of Nursing
Deborah Macklin
Phone: 478-445-4128
647 Swint Street Yarborough Building, Room 2-074
Milledgeville GA 31062
Agency Email: deborah.macklin@dbhdd.ga.gov
Expiration Date: 2018-05-31
Sent to Facility:
Sent to Provost: 2017-03-23
Sent to Legal:
Completed: 2017-05-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: One-Year Agreement

 
Champion Partners in Rehab
Department of Physical Therapy
Bart Hyche
Phone: 256-214-0301
11670 Arbor Oarks Road
Northport AL 35475
Agency Email: bhyche@championpartnerinrehab.com
Expiration Date: 2021-09-30
Sent to Facility: 2018-10-02
Sent to Provost: 2018-11-26
Sent to Legal:
Completed: 2018-11-30
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: 10/15/18 Facility requested COI language be added to MOU. Sent to Caroline Lombard for review and advice. 10/29/18 C. Lombard added the requested language. Sent to Facility 11/26/18 received from facility, sent to legal

 
Cherokee County Health Department
School of Nursing
Denise Bowman
Phone: (770) 345-7371
1219 Univeter Road
Canton GA 30115
Agency Email: denise.bowman@dph.ga.gov
Expiration Date: 2018-03-31
Sent to Facility: 2015-01-26
Sent to Provost: 2015-03-09
Sent to Legal:
Completed: 2015-03-26
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: renewal sent 2/23/18

 
Cherokee County School District
Department of Nutrition
Linda Dittrich
Phone: 770-721-8418
135 Mountain Brook Drive Bldg F
Canton GA 30115
Agency Email: Linda.Dittrich@cherokee.k12.ga.us
Expiration Date:
Sent to Facility: 2018-08-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Non clinical 8/31/18 MOU emailed There is an amendment with auto-renew language. I asked them for a copy as we do not have it in our files. 9/12/18 9/12/18 received and uploaded to database.

 
Winship Research Informatics
Health Informatics
Madhusmita Behera
Phone: 404-778-2923
1365-C Clifton Road NE
Atlanta Georgia 30322
Agency Email: mbehera@emory.edu
Expiration Date:
Sent to Facility: 2018-08-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: 8/31/18 MOU emailed

 
Tricounty Therapy
Department of Occupational Therapy
Amy Elgin
Phone: 843-438-4316
9565 Highway 78 Building 700 Ste 102
Ladson SC 29456
Agency Email: amy@tricountytherapy.com
Expiration Date: 2020-11-30
Sent to Facility: 2017-10-24
Sent to Provost: 2017-10-31
Sent to Legal:
Completed: 2017-11-08
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:

 
Childrens Hospital of Richmond
Department of Physical Therapy
Regena Mayo
Phone: 804-828-2467
1000 East Broad Street
Richmond VA 23220
Agency Email: regena.mayo@vcuhealth.org
Expiration Date:
Sent to Facility: 2016-07-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: MOU & COI emailed.

 
Brain Injury Association of Georgia, Inc.
Department of Occupational Therapy
Jane Jackson
Phone: 404-712-5504
PO Box 2817
Woodstock GA 30188
Agency Email: jane@braininjurygeorgia.org
Expiration Date: 2023-06-30
Sent to Facility: 2020-02-18
Sent to Provost: 2020-08-05
Sent to Legal:
Completed: 2020-08-10
Requester Name: Carolyn Podolski
Document 1: ExpJun2023 BrainInjury forProvost signed
Document 2:
Document 3:
Comment: We plan to work with them again in fall 2020, so we would like to go ahead and get the renewal sent now. Thanks! - Letitia

 
Clinica Materna Infantal
School of Nursing
Dalia Nava
Phone: 770-734-0999
2078 Beaver Ruin Road Suite 500
Norcross GA 30071
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-08-09
Sent to Provost: 2013-08-15
Sent to Legal:
Completed: 2013-08-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Cobb and Douglas County Community Services Board
Department of Nutrition
Maurice Jones
Phone: 770-499-2422
331 North Marietta Parkway
Marietta GA 30060
Agency Email:
Expiration Date: 2012-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Cobb-Douglas Community Services Board
School of Nursing
Shannon Rippy
Phone: 770-429-5000
3830 South Cobb Drive Suite 300
Smyrna GA 30080
Agency Email: srippy@cobbcsb.com
Expiration Date:
Sent to Facility: 2014-11-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: MOU e-mailed

 
Coffee Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Denise Mooney
Phone: 912-383-5645
PO Box 1287
Douglas GA 31534
Agency Email: denise.mooney@coffeeregional.org
Expiration Date: 2015-11-30
Sent to Facility: 2019-03-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Coker Pediatrics, LLC
School of Nursing
Roberta Goodwin
Phone: 678-688-1580
14557 Highyway 19 Suite A
Griffin GA 30224-9582
Agency Email: rgoodwin@cokerpediatrics.com
Expiration Date: 2019-06-30
Sent to Facility: 2019-07-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: please renew

 
Southwest Public Health District 8, Unit 2
Department of Physical Therapy
Shamia Riser
Phone: 229-352-4275
1109 North Jackson Street Office of Nursing and Clinical Services
Albany GA 31701-2022
Agency Email: shamia.riser@dph.ga.gov
Expiration Date: 2023-05-31
Sent to Facility: 2019-11-15
Sent to Provost: 2019-11-21
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Exp May 2020 GA State Univ 2017- 2020
Document 2: Amendment to add Dental Hygene
Document 3: Final Exp May 2023 ...1856_001pdf
Comment: Southwest Public Health District 8, Unit 2, which encompasses clinical facilities in the Georgia counties of Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, and Worth 12/20/19 uploaded final exp may2023 to 3rd doc

 
Columbia County Health Department-Harlem/Grovetown Office
School of Nursing
Janette Daniel
Phone: 706-667-4329
Richmond County Health Department 1916 North Leg Road
Augusta GA 30909
Agency Email:
Expiration Date: 2012-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sandra Hewell
Document 1: view
Document 2:
Document 3:
Comment: (Fan Mitchell, Grovetown)

 
Community Advanced Practice Nurses, Inc.
School of Nursing
Connie Buchanan
Phone: 404-815-1811
173 Boulevard NE
Atlanta GA 30312
Agency Email: connie.buchanan@capn.org.
Expiration Date: 2023-04-30
Sent to Facility: 2020-03-30
Sent to Provost: 2020-03-31
Sent to Legal:
Completed: 2020-05-18
Requester Name: Lisa Williams
Document 1: ExpApr2023 CAPNScan-202003301701
Document 2:
Document 3:
Comment: 5-12-20 followed up with Kisha

 
Community Care MD
School of Nursing
Jane Ling
Phone: 678-720-0422, x310
5019 LaVista Road
Tucker GA 30084
Agency Email:
Expiration Date: 2015-07-31
Sent to Facility: 2012-07-13
Sent to Provost: 2012-07-17
Sent to Legal:
Completed: 2012-07-25
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Community Rehabilitation Services, Inc. (CRSI) d/b/a Integra Rehabilitation
Department of Physical Therapy
Bernice Cash
Phone: 706-278-4438
Integra Rehabilitation 1013 Riverburch Parkway, Suite 2
Dalton GA 30721
Agency Email: bernicecash@integrarehab.org
Expiration Date: 2018-04-30
Sent to Facility: 2018-11-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 9/13/18 MOU Emailed 11/20/18 sent MOU to facility again for signature- Provost signed their memo 11/20/18 Sent MOU to Facility for signature

 
Complete Care for Women, PC
School of Nursing
Mindy Fine
Phone: 770-435-7755
1675 Cumberland Parkway, SE Suite 106
Smyrna GA 30080
Agency Email: mfinemd@msn.com
Expiration Date: 2019-08-31
Sent to Facility: 2016-09-01
Sent to Provost: 2016-09-07
Sent to Legal:
Completed: 2019-09-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: This practice closed in 2017.

 
Concentra Health Services, Inc. dba Concentra Medical Services
Department of Physical Therapy
Laurie Osielski
Phone: 262-814-2503
2455 N. 124th Street
Brookfield WI 53005
Agency Email:
Expiration Date: 2022-03-30
Sent to Facility: 2016-05-11
Sent to Provost: 2017-03-31
Sent to Legal:
Completed: 2017-04-27
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Amend Renewal emailed. Sent their amendment renewal to Legal for review 5/17. Facility did not agree to indemnification, sent to Legal for review 2/2/17. Changes accepted and sent to Legal for Provost signature 3/22. Sent to facility for signature 4/13.

 
Consistent Care Family Practice
School of Nursing
Denise Carson
Phone: 706-638-4979
204 South Chattanooga Street
Lafayette GA 30728-2806
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:

 
Medical Center, LLP
School of Nursing
Tracy McDaniel
Phone: 478-272-7411
908 Hillcrest Parkway
Dublin GA 31021
Agency Email: tmcdaniel@dublinmedicalcenter.com
Expiration Date: 2020-11-30
Sent to Facility: 2017-10-24
Sent to Provost: 2017-10-31
Sent to Legal:
Completed: 2017-11-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Bliss Primary and Urgent Care PC
School of Nursing
Yonas Tamene
Phone: 404-808-2125
4600 E. Ponce De Leon Avenue Suite A
Clarkston GA 30021-1839
Agency Email: yonas_tamene@hotmail.com
Expiration Date: 2021-06-20
Sent to Facility: 2018-06-26
Sent to Provost: 2018-07-30
Sent to Legal:
Completed: 2018-08-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/30/18 to Legal 8/13/18 MOU emailed to all parties

 
Aspire Behavioral Health & Developmental Disability Services
BFLCNHP
Helen Jones
Phone: 229-430-1360
1120 West Broad Avenue
Albany GA 31702
Agency Email: HSims@albanycsb.org
Expiration Date: 2024-04-30
Sent to Facility: 2017-10-24
Sent to Provost: 2017-10-30
Sent to Legal:
Completed: 2021-04-30
Requester Name: Lisa Williams
Document 1: Aspire Behavioral Health & Developmental Disability_exp_4-30-2024
Document 2:
Document 3:

 
Personal Care Physicians of Atlanta
School of Nursing
Marc Seltman
Phone: 404-256-3135
5673 Peachtree Dunwoody Road Suite 950
Atlanta GA 30342
Agency Email: mseltman@pcpatl.net
Expiration Date: 2020-08-31
Sent to Facility: 2017-08-09
Sent to Provost: 2017-08-22
Sent to Legal:
Completed: 2017-08-28
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: MOU complete

 
Covenant Health
Department of Physical Therapy
Nancy Donoho
Phone: 8653741000
9041 Executive Park Drive Suite 250
Knoxville TN 37923
Agency Email:
Expiration Date: 2015-12-31
Sent to Facility: 2011-10-26
Sent to Provost: 2011-11-28
Sent to Legal:
Completed: 2012-01-10
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Internal Medicine of Griffin
BFLCNHP
Linda Cunningham
Phone: 770-227-1587
619 South 8th Street Suite 200
Griffin GA 30224
Agency Email: Lcunningham@villagemedical.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-28
Sent to Provost: 2018-01-01
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
C-Worth Family Walk-In Clinic, LLC
School of Nursing
Kelly R. Elliot
Phone: 706-517-0656
2976 Highway 76 Suite B&C
Chatsworth GA 30705
Agency Email: k.elliott@windstream.net
Expiration Date: 2013-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
DaVita Dialysis Contracting, LLC
Department of Nutrition
Kate Anderson
Phone: 615-320-4419
5200 Virginia Way
Brentwood TN 37027
Agency Email: kate.anderson1@davita.com
Expiration Date: auto renews
Sent to Facility: 2019-06-10
Sent to Provost: 2019-06-03
Sent to Legal: 2019-01-24
Completed: 2019-06-13
Requester Name: Jessica Todd
Document 1:
Document 2: Davita Full 2014
Document 3: Final June2019 Auto Renews
Comment: 12/19/18 email to Halley Walton is undeliverable. 1/17/19 sent to new contact. 1/23/19 Facility sent their template with auto-renew language. sent to legal for review 3/21/19 To facility for review 5/30/19 to C. Lombard for final review 6/3/19 Lombard routed to provost 6/10/19 to facility for final signature

 
Dawson Pediatrics
BFLCNHP
Stephen Tolson
Phone: 706-216-2771
300 Dawson Commons Circle Suite 320
Dawsonville GA 30534-6268
Agency Email: stephen@dawsonpediatrics.com
Expiration Date: 2020-11-30
Sent to Facility: 2020-09-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
DBHDD Georgia Regional Hospital at Savannah
Byrdine F Lewis School of Nursing and Health Professions
Barbara E Medeiros
Phone: 912-356-2546
1915 Eisenhower Boulevard
Savannah GA 31406
Agency Email: Barbara.Medeiros@dbhdd.ga.gov
Expiration Date:
Sent to Facility: 2019-04-26
Sent to Provost: 2019-03-04
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/4/19 to legal for review of their document 4/26/19 Provost signed, to facility for signatures

 
DCH Healthcare Authority
Department of Physical Therapy
Kaye H Winters
Phone: 205-333-4339
Northport Medical Center, 2700 Hospital Drive
Northport AL 35476
Agency Email: kwinters@dchsystem.com
Expiration Date: 2019-10-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-12-04
Sent to Legal:
Completed: 2019-12-20
Requester Name: Carla Huggins
Document 1: Exp Oct 2022 ...DCH Healthcare Auth.pdf
Document 2:
Document 3:
Comment: 12/19/19 Received scanned copy, facility requests original be mailed. Asked Kisha for original to send to facility. uploaded final in first document DCH Healthcare Auth.pdf

 
DeKalb Community Service Board
BFLCNHP
Veronica Codling
Phone: 4045087963
445 Winn Way 4th Floor
Decatur GA 30030
Agency Email: veronica@dekcsb.org
Expiration Date: 2022-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: This name is also listed as a contact - Nicole Scales- 404- 508-7963 - nicoles@dekcsb.org

 
DeKalb Comprehensive Physical Therapy, Limited Partnership
Department of Physical Therapy
Leon Pegg
Phone: 678-418-8072
2410 DeKalb Medical Parkway Suite E
Lithonia GA 30058
Agency Email: lpegg@usph.com
Expiration Date: 2026-10-31
Sent to Facility: 2018-10-24
Sent to Provost: 2018-10-29
Sent to Legal:
Completed: 2021-07-21
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
DeKalb County Board of Health
Byrdine F Lewis School of Nursing and Health Professions
Linda O Sullivan
Phone: 404-294-3798
445 Winn Way Suite 527
Decatur GA 30030
Agency Email: Linda.OSullivan@dph.ga.gov
Expiration Date:
Sent to Facility: 2019-09-18
Sent to Provost:
Sent to Legal: 2019-10-07
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 11/22/19 Cannot agree to contract terms. Facility requires GSU provide free classes to their staff.

 
DeKalb Family Practice & Geriatrics, LLC
School of Nursing
Sudha Challa
Phone: 770-458-8497
4961 Buford Highway Suite 100
Atlanta GA 30341
Agency Email: info@dekalbmedicalclinic.com
Expiration Date: 2021-08-31
Sent to Facility: 2018-08-15
Sent to Provost: 2018-10-11
Sent to Legal:
Completed: 2018-10-26
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
DeKalb Regional Health System
Byrdine F Lewis School of Nursing and Health Professions
Joel Schuessler
Phone: 404-501-5790
2701 North Decatur Road
Decatur GA 30033
Agency Email: joel.schuessler@dekalbmedical.org
Expiration Date: 2021-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires December 2021
Document 2:
Document 3:
Comment: Merged with Emory.

 
ENT Institute
Health Informatics
Shannon Murray
Phone: 770-817-3254
925 North Point Pkwy Suite 130
Alpharetta Georgia 30005
Agency Email: smurray@nsainstitute.com
Expiration Date: 2021-09-30
Sent to Facility: 2018-10-19
Sent to Provost: 2018-11-02
Sent to Legal:
Completed: 2018-11-30
Requester Name: Cedric Truss
Document 1: view
Document 2:
Document 3:

 
Department of Community Health, Coastal Health District
Department of Nutrition
Tonya Scott
Phone: 912-262-3003
150 Scranton Connector
Brunswick GA 31525
Agency Email:
Expiration Date: 2013-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Cathrine McCarroll
Document 1:
Document 2:
Document 3:

 
Department of Veterans Affairs, Salem VA
Department of Physical Therapy
Mary Bryant
Phone: 540-982-2463, x1442
1970 Roanoke Boulevard Department of Physical Therapy-117c
Salem VA 24153
Agency Email: Mary.Bryant3@va.gov
Expiration Date: 2031-06-30
Sent to Facility: 2012-02-06
Sent to Provost: 2012-05-19
Sent to Legal:
Completed: 2022-02-11
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Expires 06/30/2031

 
Dermatologic Surgery Specialists
School of Nursing
Todd Williams
Phone: 478-742-2180
308 Coliseum Drive Suite 200
Macon GA 31217
Agency Email:
Expiration Date: 2017-06-30
Sent to Facility: 2014-06-09
Sent to Provost: 2014-06-18
Sent to Legal:
Completed: 2014-07-14
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: MOU mailed;rec'd & sent to Legal for Provost sig 7/8/14

 
Dermatology Center of Atlanta
School of Nursing
Lisa Foreman
Phone: 770-497-0699
9900 Medlock Bridge Road
Duluth GA 30097
Agency Email:
Expiration Date: 2013-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1: view
Document 2:
Document 3:

 
Development in Gardening
Department of Nutrition
Sarah Koch
Phone: 619-274-7218
PO Box 18138
Denver CO 80218
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-03-08
Requester Name: Cathrine McCarroll
Document 1:
Document 2:
Document 3:

 
Diabetes and Endocrinology Associates, PC
Department of Nutrition
Jennifer Rushing
Phone: 404-299-2223, x113
2665 North Decatur Road Suite 520
Decatur GA 30033
Agency Email: jenmrushing@gmail.com
Expiration Date: 2017-10-31
Sent to Facility: 2014-11-05
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-11-18
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:

 
Diabetes Association of Atlanta, Inc.
Department of Nutrition
Carol Johnson Davis
Phone: 404-527-7150
100 Edgewood Avenue Suite 1004
Atlanta GA 30303-3067
Agency Email: kmick@diabetesatlanta.com
Expiration Date: 2017-12-31
Sent to Facility: 2014-11-12
Sent to Provost: 2014-11-20
Sent to Legal:
Completed: 2014-12-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
District Four Health Services
Byrdine F Lewis School of Nursing and Health Professions
Roxanne Gay
Phone: (706) 845-4035
122A Gordon Commercial Drive
LaGrange GA 30240
Agency Email: roxanne.gay@dph.ga.gov
Expiration Date: 2023-02-05
Sent to Facility: 2019-12-20
Sent to Provost:
Sent to Legal: 2019-12-04
Completed: 2020-01-02
Requester Name: Jessica Todd
Document 1: Exp Feb 2023 ...Dist4HealthServices.pdf
Document 2:
Document 3:
Comment: covers Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar,Merriweather, Pike, Spalding, Troup, and Upson. 12/20 provost signed, sent to facility for signature

 
Douglas County School System, School Nutrition Program
Department of Nutrition
Danielle Freeman
Phone: 770-651-2300
PO Box 1077
Douglasville GA 30133
Agency Email: Danielle.Freeman@dcssga.org
Expiration Date: 2021-08-31
Sent to Facility: 2018-09-04
Sent to Provost: 2018-09-13
Sent to Legal:
Completed: 2018-09-18
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: 8/31/18 Hanlin email undeliverable. Emailed J. Todd for new contact. 9/4/18 MOU Emailed 9/13/18 to legal

 
Dr. Lydey and Atlanta Health Institute, LLC
Department of Nutrition
William Lyday
Phone: 770-926-5459
3078 Peachtree Dr, NE
Atlanta GA 30305
Agency Email:
Expiration Date: 2012-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Cathrine McCarroll
Document 1:
Document 2:
Document 3:

 
Dr. Marisa Lawrence, FACS
School of Nursing
Marisa Lawrence
Phone: 404-303-7004
960 johnson Ferry Road Suite 120
Atlanta GA 30342
Agency Email:
Expiration Date:
Sent to Facility: 2012-12-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: DOES NOT WISH TO PARTICIPATE

 
Dr. Mary Beth Wiles
School of Nursing
Jill Nielsen
Phone: 706-745-5541
374-A Pat Haralson Drive
Blairsville GA 30512
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:

 
Dr. Miniyars Pediatrics, PC
School of Nursing
Tabitha Stubbs
Phone: 706-232-1300, x15
140 Three Rivers Drive
Rome GA 30161
Agency Email:
Expiration Date: 2013-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:

 
Dr. Precious Braswell
School of Nursing
Kendra McDuffie
Phone: 404-344-9333
2885 Headland Drive
East Point GA 30244
Agency Email:
Expiration Date: 2013-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Hewell
Document 1: view
Document 2:
Document 3:

 
Dr. Timothy C Dindoffer
School of Nursing
Nancy Giammarella
Phone: 706-271-0076
1107 Memorial Drive Suite 301
Dalton GA 30720
Agency Email:
Expiration Date: 2012-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Keiser
Document 1: view
Document 2:
Document 3:

 
Drayer Physical Therapy Institute
Department of Physical Therapy
Ashlee Jones
Phone: 717-920-2197
8205 Presidents Drive 2nd floor
Hummelstown PA 17036
Agency Email: ashleejones@drayerpt.com
Expiration Date: 2018-04-30
Sent to Facility: 2019-07-08
Sent to Provost: 2019-05-28
Sent to Legal: 2019-05-08
Completed: 2019-07-09
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Site prefers MOU in Microsoft Word Copy ptclinicaleducation@gsu.edu

 
Dunwoody Obstetrics and Gynecology, PC
School of Nursing
Alvin Sermons
Phone: 770-551-9616
1829 Independence Square Suite 1
Dunwoody GA 30338
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-08-23
Sent to Provost: 2013-08-29
Sent to Legal:
Completed: 2013-09-16
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Dunwoody Physicians Family Medicine
School of Nursing
J. Patel
Phone: 770-394-7868
8095-A Roswell Road
Atlanta GA 30350
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-08-28
Sent to Provost: 2013-09-13
Sent to Legal:
Completed: 2013-09-18
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Eagle Drive Family Medicine, PC
School of Nursing
Rene Manrique
Phone: 678-445-5995
1816 Eagle Drive Suite 200-B
Woodstock GA 30189
Agency Email:
Expiration Date: 2013-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:

 
Georgia Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Michelle Woods
Phone: 912-486-1000
1499 Fair Road
Statesboro GA 30458
Agency Email:
Expiration Date: 2015-09-30
Sent to Facility: 2016-05-04
Sent to Provost: 2016-05-16
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sent to Legal for Provost 5/11/16. Sent to facility for 5/18. Followed up with Ms. Ray 6/29/16.

 
Gwinnett County Board of Health
Department of Nutrition
Rachel Cordle
Phone: 678-442-6895
2570 Riverside Parkway PO Box 897
Lawrenceville GA 30046
Agency Email: rachel.cordle@gnrhealth.com
Expiration Date: 2022-06-30
Sent to Facility: 2019-03-28
Sent to Provost: 2019-06-12
Sent to Legal:
Completed: 2019-06-14
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
East Metro Health District
BFLCNHP
Alana Sulka
Phone: 770-339-4260
Gwinnett, Newton, and Rockdale County Health Departments PO Box 897
Lawrenceville GA 30046-0897
Agency Email: alana.sulka@gnrhealth.com
Expiration Date:
Sent to Facility: 2013-06-24
Sent to Provost: 2013-07-17
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: see Gwinnett County Board of Health- Newton, Rockdale, & Gwinnett Co BOH Includes Norcross, Buford, Lawrenceville- Signed by Dr. Palms ; sent to agency 7/25/13; called to follow up last on 3/26/14.

 
Eduglobal Associates
Department of Physical Therapy
Brett Windsor
Phone: 630-423-1154
PO Box 2038
Indiana PA 15701
Agency Email: info@eduglobalassociates.org
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-16
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Site has their own template https://brettwindsor00227.app.box.com/s/xnz01n2c795fzgntuhmn 72jp6oh4buer Please copy ptclinicaleducation@gsu.edu

 
Emory Rehabilitation Hospital in Partnership with Select Medical
Department of Occupational Therapy
Chauntoiya Jones
Phone: 404 712 1958
1441 Clifton Rd NE
Atlanta GA 30322
Agency Email: chauntoiya.jones@emoryhealthcare.org
Expiration Date:
Sent to Facility:
Sent to Provost: 2018-11-21
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: MOU emailed. 11/21/18 received hard copies of their agreement. sent via inter office mail to Kisha for legal review and signature.

 
Elite Family Practice PC
School of Nursing
Delania Miles
Phone: 678-715-2993
6126 Prestley Mill Road Suite H
Douglasville GA 30134
Agency Email: delania@elitefamilypractice.com
Expiration Date: 2014-12-31
Sent to Facility: 2014-11-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: Renewal e-mailed

 
Ellis Physical Therapy Associates, Inc.
Department of Physical Therapy
Austin Holley
Phone: 803-779-8327
1519 Taylor Street
Columbia SC 29201
Agency Email:
Expiration Date: 2025-03-31
Sent to Facility: 2019-04-11
Sent to Provost: 2019-10-10
Sent to Legal:
Completed: 2022-03-22
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
Eastside Medical Center
Department of Occupational Therapy
Janet McLaren
Phone: 770-736-2579
1700 Medical Way P O Box 587
Snellville GA 30078
Agency Email: janet.mclaren@hcahealthcare.com
Expiration Date: 2022-10-21
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-10-22
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Division of Tristar, covered under Tristar Health System Inc. Janet McLaren and cc Margaret Crawford: janet.mclaren@hcahealthcare.com and Dba TriStar Health System margaret.crawford2@hcahealthcare.com

 
Emory Metabolic Nutrition Program
Department of Nutrition
Ken M. Loud
Phone: 404-778-8553
Department of Human Genetics, Division of Medical Genetics 2165 North Decatur Road
Decatur GA 30033-5307
Agency Email: kloud@emory.edu
Expiration Date: 2020-09-30
Sent to Facility: 2020-8-25
Sent to Provost: 2020-08-17
Sent to Legal: 2020-08-11
Completed: 2020-09-15
Requester Name: Jessica Todd
Document 1: EmoryMetabolicNutrition ExpSept2020pdf
Document 2:
Document 3:
Comment: non clinical

 
Emory Healthcare, Inc. - Nursing Programs
School of Nursing
Elizabeth Botheroyd
Phone: 404-686-2429
550 Peachtree Street
Atlanta GA 30308
Agency Email: elizabeth.botheroyd@emoryhealthcare.org
Expiration Date: 2023-08-31
Sent to Facility:
Sent to Provost: 2020-04-24
Sent to Legal:
Completed: 2020-05-04
Requester Name: Lisa Williams
Document 1: Final Expires August 2020
Document 2: Amendment to add RT
Document 3: Exp Aug 2023 ...Emory GSU Nursing pdf
Comment: complete. uploaded full doc in doc 3 5-12-2020

 
Ridgeview Institute
Byrdine F Lewis School of Nursing and Health Professions
Nandini Kamalaker
Phone: (844) 350-8800
709 Breedlove Drive
Monroe GA 30655
Agency Email: nkamalaker@ridgeviewmonroe.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:

 
Rising Stars Childrens Therapy at In Harmony Pediatric Therapy
Department of Occupational Therapy
Kristi Estes
Phone: 770-687-2542
9880 Hickory Flat Highway
Woodstock GA 30188
Agency Email: kestes@inharmonypediatrictherapy.com
Expiration Date:
Sent to Facility: 2020-06-16
Sent to Provost: 2020-09-02
Sent to Legal:
Completed: 2020-09-11
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:

 
Emory-Adventist Hospital at Smyrna
Byrdine F Lewis School of Nursing and Health Professions
Tenia Nichols
Phone: (770) 438-5241
Administrative Office 3949 South Cobb Drive
Smyrna GA 30080-6300
Agency Email:
Expiration Date: 2015-11-30
Sent to Facility: 2012-11-13
Sent to Provost: 2012-11-28
Sent to Legal:
Completed: 2012-12-13
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Will cease operation on 10/31/2014.

 
Enduracare Therapy Management, Inc.
Department of Physical Therapy
Emily Russell
Phone: 703-321-6939
1 Forest Park Drive
Farmington CT 06032
Agency Email:
Expiration Date: 2014-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-03-04
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Agreement NO LONGER VALID-Company was bought out

 
Anchor Hospital
Byrdine F Lewis School of Nursing and Health Professions
Nora Sinyard
Phone: 678-251-3200
1000 Eagles Landing Parkway
Stockbridge Georgia 30281
Agency Email: nora.sinyard@uhsinc.com
Expiration Date: 2024-08-10
Sent to Facility: 2020-09-08
Sent to Provost:
Sent to Legal:
Completed: 2021-08-17
Requester Name: Lisa Williams
Document 1: UHS of Anchor, LP, d/b/a Anchor Hospital
Document 2: UHS of Anchor
Document 3:
Comment: Includes Stockbridge and Anchor Campuses UHS of Anchor, LP, d/b/a Anchor Hospital

 
My Sports Dietitian
Department of Nutrition
Ronnie Harper
Phone: 225-323-4372
0
Gonzales Louisiana 0
Agency Email: mysportsdietitian@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical do not have the full address emailed to request but wanted to get started student starting in May.

 
Southern Rehab and Sports Medicine, Inc.--PT
Department of Physical Therapy
David Buuck
Phone: 706-845-9383
1805 Vernon Road Suite A
LaGrange GA 30240
Agency Email: david.buuck@southernrehab.com
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-11-18
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
Southern Rehabilitation Services of Stephens County Hospital
Department of Physical Therapy
Lynne Anderson
Phone: 706-282-4200
163 Hospital Drive
Toccoa GA 30577
Agency Email: pphillips@stephenscountyhospital.com
Expiration Date: 2020-07-31
Sent to Facility: 2020-02-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 2/18/2020 Lynne Anderson email undeliverable

 
Southern Therapy Services, Inc.
Department of Physical Therapy
George B Hamil, Jr
Phone: (770) 834-7436
120 East Center Street
Carrollton GA 30117
Agency Email: sevans@southerntherapy.org
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-22
Requester Name: Carla Huggins
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment: Bremen, Lithia Springs, LaGrange, Carrolton Please copy ptclinicaleducation@gsu.edu

 
Southside Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Donna Sinclair
Phone: (404) 688-1350, ext 540
1046 Ridge Avenue, SW
Atlanta GA 30315
Agency Email: DSinclair@smcmed.com
Expiration Date: 2024-06-30
Sent to Facility: 2018-07-12
Sent to Provost:
Sent to Legal:
Completed: 2021-06-23
Requester Name: Lisa Williams
Document 1: Southside Medical Center
Document 2:
Document 3:
Comment:

 
Sandy Springs Pediatrics and Adolescent Medicine, PC
Byrdine F Lewis School of Nursing and Health Professions
Janee Lowery
Phone: 404-252-4611
993 Johnson Ferry Road NE
Atlanta GA 30342
Agency Email: Jlowery@sspediatrics.com
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 06/23/2021
Requester Name: Lisa Williams
Document 1: Sandy Springs Pediatrics and Adolescent Medicine, PC
Document 2:
Document 3:

 
Avant Gynecology
Byrdine F Lewis School of Nursing and Health Professions
Jenny Davis
Phone: 404-352-2850
105 Collier Road Suite 1080
Atlanta GA 30309
Agency Email: jenny@avantgynecology.com
Expiration Date: 2022-12-31
Sent to Facility: 2019-12-19
Sent to Provost: 2020-01-14
Sent to Legal:
Completed: 2020-01-17
Requester Name: Lisa Williams
Document 1: exp dec 2022 AvantGynecology_DEC2019
Document 2:
Document 3:

 
Sovereign Rehabilitation
Department of Occupational Therapy
Alan J Grodin
Phone: 404-835-3340
5555 Peachtree Dunwoody Road
Atlanta GA 30342
Agency Email:
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-24
Sent to Legal:
Completed: 2020-01-30
Requester Name: Carolyn Podolski
Document 1: exp dec 2022 ...4122632.pdf
Document 2:
Document 3:
Comment: If possible, please expedite this contract. We are interested in their Lawrenceville location with an OT named Tanja Taylor tanja.taylor@sovereignrehab.com. -Letitia Carelock lcarelock@gsu.edu. 1/21/2020 Site does not have a full time OT on site to take on a clinical student. Marking inactive

 
Spine and Sport
Department of Physical Therapy
Melissa Fender
Phone: 912-826-3797
135 Goshen Road Suite 206
Savannah, GA GA 31326
Agency Email:
Expiration Date: 2011-10-31
Sent to Facility: 2012-08-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Sports and Orthopedic Rehabilitation Services and Sports and Orthopedic Rehabilitation Services
Department of Physical Therapy
Erika Fisher Shamash
Phone: 717-975-4791
Select Medical Corporation 4716 Old Gettysburg Road
Mechanicsburg PA 17055
Agency Email:
Expiration Date:
Sent to Facility: 2013-08-22
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sports & Orthopedic Rehab Team

 
Ankle & Foot Centers of Georgia
Department of Physical Therapy
Kelli Whitlock
Phone: 678.561.9000
1975 Highway 54 West Suite 205
Peachtree City GA 30269
Agency Email: kwhitlock@medmanagement.net
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-07-20
Requester Name: Carla Huggins
Document 1: Ankle & Foot Centers of Georgia
Document 2:
Document 3:
Comment: Copy Masiki Williamson (ptclinicaleducation@gsu.edu) on communication. Thank you.

 
SportsMedicine of Atlanta, Inc.
Department of Physical Therapy
Robert E DuVall
Phone: 770-979-1400
2138 Scenic Highway Suite B
Snellville GA 30078
Agency Email: reduvall@bellsouth.net
Expiration Date: 2021-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
St Claire Regional Medical Center
Department of Physical Therapy
Debra Neff
Phone: 606-783-6654
222 Medical Circle
Morehead KY 40351
Agency Email: Carla.Terry@st-claire.org
Expiration Date: 2017-04-30
Sent to Facility: 2018-08-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 8/29/18 MOU Emailed Carla Terry, C-TAGME | Director, GME, Grants & Contracts 222 Medical Circle | Morehead, KY 40351 p 606.783.8995 | f 606.784.2767 | www.st-claire.org 7/18/18 2:57PM Emailed carla and masiki asking for clarification of contact information

 
Tennova Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Hope Hubbard
Phone: 865-545-3145
Tennova Healthcare - Physicians Regional Medical Center 900 E Oak Hill Avenue
Knoxville TN 37917
Agency Email: Anna.hubbard@hma.com
Expiration Date: 2015-02-15
Sent to Facility: 2015-02-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Metro knoxville HMA; Physicians Regional Medical Center Renewal emailed.

 
Stockbridge Pediatrics, PC
School of Nursing
Marixie Gilrane
Phone: 770-506-0095
239 Village Center Parkway Suite 110
Stockbridge GA 30281
Agency Email:
Expiration Date: 2012-05-10
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sandra Hewell
Document 1: view
Document 2:
Document 3:

 
Summit Urgent Care, LLC
School of Nursing
Brittney Walls
Phone: 770-502-2114
1755 Highway 34 East Suite 2150
Newnan GA 30265
Agency Email:
Expiration Date:
Sent to Facility: 2012-12-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: MOU e-mailed to Britteny Walls

 
Sutter Family Practice, Inc.
School of Nursing
Patricia Stevenson
Phone: 706-695-0466
320 Market Street PO Box 709
Chatsworth GA 30705
Agency Email: patricia@sutterfamilypractice.com
Expiration Date: 2020-11-30
Sent to Facility: 2020-09-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/16/20 not renewing contract per Patricia Stevenson, Practice Manager

 
Suwanee Family Physicians
School of Nursing
John Y Shih
Phone: 770-831-8191
960 Peachtree Industrial Blvd
Suwanee GA 30024
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:

 
Suwanee Pediatrics, PC
BFLCNHP
Neili Zamora
Phone: 678-442-1922
1155 Lawrenceville-Suwanee Rd
Suwanee GA 30043
Agency Email: Administrator@suwaneepediatrics.com
Expiration Date: 2025-01-31
Sent to Facility: 2019-01-23
Sent to Provost: 2019-04-16
Sent to Legal:
Completed: 2022-06-06
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment:

 
Sy Med, LLC
School of Nursing
Bob Erramilli
Phone: 770-414-5588
155 Lee Byrd Road
Loganville GA 30052
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1: view
Document 2:
Document 3:

 
Tanner Medical Center, Inc.
Byrdine F Lewis College of Nursing and Health Professions
Mindy Harris
Phone: 770-812-3945
20 Herrell Road
Villa Rica GA 30180
Agency Email: meharriss@tanner.org
Expiration Date: 2023-03-31
Sent to Facility: 2020-03-17
Sent to Provost: 2020-03-23
Sent to Legal:
Completed: 2020-03-31
Requester Name: Lisa Williams
Document 1: exp mar2023 Tanner Health MOU - signed
Document 2:
Document 3:

 
Tara Therapy, LLC
Department of Physical Therapy
Jackie Burke
Phone: 888-411-4196
3690 Southwestern Boulevard PO Box 0428
Orchard Park NY 14127
Agency Email:
Expiration Date: 2012-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
Temple Medical Clinic
School of Nursing
Lori Hudson
Phone: 770-462-1170
503 Main Street
Villa Rica GA 30180
Agency Email: medicinewoman5@yahoo.com
Expiration Date: 2022-11-30
Sent to Facility: 2019-10-31
Sent to Provost: 2019-11-06
Sent to Legal:
Completed: 2019-11-07
Requester Name: Lisa Williams
Document 1: Exp Nov 2022 doc...140359
Document 2:
Document 3:

 
Tender Ones Therapy Services - PT
Department of Physical Therapy
Noreen Zulaica
Phone: 770-904-6009
2089 Teron Trace Suite 120
Dacula GA 30019
Agency Email: therapy@tenderones.com
Expiration Date: 2023-01-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-22
Sent to Legal:
Completed: 2019-10-23
Requester Name: Carla Huggins
Document 1: Expires January 2020 PT ONLY
Document 2: Exp Jan 2023 doc03472320191023101926
Document 3:

 
Spalding Regional Medical Center, inc
Byrdine F Lewis School of Nursing and Health Professions
Cortney Whitehouse
Phone: 770-229-6463
601 S 8th Street P O Drawer V
Griffin GA 30224
Agency Email: cortney.whitehouse@tenethealth.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-11-14
Sent to Provost: 2015-01-09
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: NS, RT, NT, PT, Spalding Regional Hospital Covered under Wellstar agreement

 
WellStar Atlanta Medical Center Inc.
Byrdine F Lewis School of Nursing and Health Professions
Wendy Jones
Phone: 404-265-4641
303 Parkway Drive, NE Box 403
Atlanta GA 30312-1212
Agency Email: Wendy.jones@wellstar.org
Expiration Date: 2018-09-11
Sent to Facility: 2018-08-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: Previously known as Tenet Healthsystem Gb, INC Atlanta Medical Center; South Fulton Medical Center, includes Georgia State Health Clinic Wendy Jones is contract person however it will be signed by Kim Ryan, Hospital President. renewal document sent 8/6/18

 
Center Helping Obesity in Children End Successfully, Inc.
Department of Nutrition
Chelsei French
Phone: 678-819-3663
1275 Shiloh Road, NW Suite 2660
Kennesaw GA 30144
Agency Email: cfrench@ChoicesForKids.org
Expiration Date: 2019-03-31
Sent to Facility: 2016-01-06
Sent to Provost: 2016-01-15
Sent to Legal:
Completed: 2016-02-21
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
The Children's Hospital of Alabama
Department of Physical Therapy
Martha Dorough
Phone: 205-939-9889
1600 7th Avenue South
Birmingham AL 35233
Agency Email:
Expiration Date: 2015-10-31
Sent to Facility: 2012-09-18
Sent to Provost: 2012-11-19
Sent to Legal:
Completed: 2012-12-06
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Childrens Hospital, Alabama

 
The Coca Cola Company
Department of Nutrition
Rachel Quiles
Phone: 404-436-1695
P.O. Drawer 1734
Atlanta GA 30301
Agency Email:
Expiration Date: 2025-03-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-03
Requester Name: Jessica Todd
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: Renew non clinical

 
The Doctors Inn, Inc.
School of Nursing
Jim Vlahos
Phone: 770-277-5456
1569 Buford Drive, NE
Lawrenceville GA 30043-3725
Agency Email:
Expiration Date: 2012-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
The East Clinic
BFLCNHP
Lynn Stubelt
Phone: 770-505-0531
539 Hardee Street
Dallas GA 30132
Agency Email: theeastclinic@netscape.net
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-11
Sent to Provost: 2019-01-11
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment:

 
The Emory Clinic, Inc.
School of Nursing
Michele L Miles
Phone: 404-728-6948
Fuqua Center for Late-Life Depression 1841 Clifton Road, NE
Atlanta GA 30329
Agency Email:
Expiration Date: 2016-03-12
Sent to Facility: 2011-08-23
Sent to Provost: 2012-02-12
Sent to Legal:
Completed: 2013-01-04
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: Covered Under the Emory Healthcare Agreement

 
The FitWit Foundation, Inc.
School of Nursing
Benjamin Thoele
Phone: 937-269-1557
879 Vera Street, SE
Atlanta GA 30316
Agency Email:
Expiration Date: 2012-02-29
Sent to Facility: 2011-11-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Kenya Kirkendoll
Document 1:
Document 2:
Document 3:
Comment: Called and resent 6/21/12

 
My OBGYN PC
BFLCNHP
Linda Bailey
Phone: 770-966-1200
906 Hampton Road
McDonough Georgia 30253
Agency Email: myobgyn.administrator@my-obgyn.org
Expiration Date: 2022-06-30
Sent to Facility: 2019-07-01
Sent to Provost: 2019-08-09
Sent to Legal:
Completed: 2019-08-08
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment:

 
Priority Medicine
School of Nursing
John Kihm
Phone: 919-471-3351
3811 N. Roxboro Road Suite B
Durham NC 27704
Agency Email: jtkihm@frontier.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-10-18
Sent to Provost: 2016-10-19
Sent to Legal:
Completed: 2016-10-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Lisa Williams: 7/1/19 I will not renew this contract at this time, please mark it as inactive.

 
The Longstreet Clinic
BFLCNHP
Ulena Miller-St.Germain
Phone: 770-533-6580
725 Jesse Jewell Parkway, Suite 270 Post Office Drawer 658
Gainesville GA 30503
Agency Email: Ulena.Miller-St.Germain@longstreetclinic.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-01-23
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Final Expires Feb 2022
Document 2:
Document 3:

 
Hope Clinic
BFLCNHP
Pamela Martin
Phone: 770-685-1300
121 Langley Drive
Lawrenceville GA 30046
Agency Email: Pam.martin@hopeclinicinc.org
Expiration Date: 2025-12-31
Sent to Facility: 2017-11-29
Sent to Provost: 2018-01-09
Sent to Legal:
Completed: 2022-01-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Evans Memorial Hospital, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Dennis Fischer
Phone: 912-739-5025
310 North River Street
Claxton GA 30417
Agency Email:
Expiration Date:
Sent to Facility: 2015-09-14
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: View
Document 2:
Document 3:
Comment: 2nd request initially sent renewal request 8/14/13.3rd request mailed 9/14/15.

 
Exalted Health & Rehab
Department of Physical Therapy
Carla Heritage
Phone: 864-348-7433
406 West Broad Street
Iva SC 29655
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility: 2011-04-30
Sent to Provost: 2011-06-14
Sent to Legal:
Completed: 2011-06-24
Requester Name: Janet Cline
Document 1:
Document 2:
Document 3:

 
Fairview Park Hospital
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Davidson
Phone: 478-274-3672
P O Box 1408
Dublin GA 31040
Agency Email: Jennifer.Davidson@hcahealthcare.com
Expiration Date: 2022-03-31
Sent to Facility: 2019-03-29
Sent to Provost:
Sent to Legal:
Completed: 2019-05-09
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Family Counseling and Recovery, Inc.
School of Nursing
Dan Dougherty
Phone: 770-386-3777
317 Grassdale Road, SE
Cartersville GA 30120-2017
Agency Email:
Expiration Date: 2012-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Chen
Document 1: view
Document 2:
Document 3:

 
Family Health Enterprise
School of Nursing
Dorothy Galloway
Phone: 404-635-1300
1350 Boulevard Avenue, SE
Atlanta GA 30315
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility: 2011-02-17
Sent to Provost: 2011-03-07
Sent to Legal:
Completed: 2011-03-11
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:
Comment: Do Not Renew-NO Longer in Operation

 
Family Practice Associates of Atlanta, PC
School of Nursing
Patricia Golden
Phone: 770-454-0091
1776 Old Spring House Lane Suite 200
Atlanta GA 30338
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-08-09
Sent to Provost: 2013-09-11
Sent to Legal:
Completed: 2013-09-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Family Practice Clinic, PC
School of Nursing
Marshia Milam-Medford
Phone: 770-963-0927
696 Grayson Highway
Lawrenceville GA 30045
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-18
Sent to Provost: 2013-11-20
Sent to Legal:
Completed: 2013-12-05
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Family Practice of Atlanta
School of Nursing
Jacquie Jones
Phone: 404-370-0602
1428 Scott Boulevard
Decatur GA 30030
Agency Email:
Expiration Date: 2013-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Fayette Community Hospital, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Jill M Fenimore
Phone: 770-719-7027
1255 Hwy 43 West
Fayetteville GA 30214
Agency Email: JillFenimore@piedmont.org
Expiration Date: 2015-12-18
Sent to Facility: 2012-11-01
Sent to Provost: 2012-12-10
Sent to Legal:
Completed: 2012-12-18
Requester Name: Caroline Lombard
Document 1:
Document 2:
Document 3:
Comment: SEE PIEDMONT HEALTHCARE, INC., Piedmont Fayette Hospital

 
Fayette County Board of Education
BFLCNHP
Renee Hammer
Phone: 770-460-3535 Ext. 179
245 Booker Road
Fayetteville GA 30314
Agency Email: hammer.renee@mail.fcboe.org
Expiration Date: 2021-07-31
Sent to Facility: 2018-06-01
Sent to Provost: 2018-06-06
Sent to Legal:
Completed: 2018-06-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 6/1/18 Renewal letter sent to K. Herron via email 6/4/18 Updated Agency Contact, resent letter 6/6/18 To legal 6/8/18 Complete, emailed to all parties 6/21/2021 - The site declined to renew contract. LYW

 
Fellowship Health & Rehab
Department of Physical Therapy
Jimmy King
Phone: 864-226-3427
208 James Street
Anderson SC 29625
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Cline
Document 1:
Document 2:
Document 3:

 
First Medical Care, Inc.
Williams
Olra Jamishivy
Phone: 770-934-6832
2536 Lawrenceville Highway
Decatur GA 30033
Agency Email: fmc_2007@yahoo.com
Expiration Date: 2022-12-31
Sent to Facility: 2018-12-19
Sent to Provost: 2019-01-17
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: Final Expires December 2022
Document 2:
Document 3:
Comment: Please send new contract. LYW

 
Floyd Healthcare Management, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Shannon Johnson
Phone: 706-509-5136
304 Turner McCall Blvd.
Rome GA 30165
Agency Email: shjohnson@floyd.org
Expiration Date: 2022-02-28
Sent to Facility: 2019-02-19
Sent to Provost:
Sent to Legal:
Completed: 2019-03-29
Requester Name: Carla Huggins
Document 1: Exp Feb2022 ...floyd_001.pdf
Document 2: Exp Feb 2022 ...floyd_001.pdf
Document 3:

 
Forsyth County Food and Nutrition Services
Department of Nutrition
Susan Woods
Phone: 770-888-3473, x202425
1140 Dahlonega Highway
Cumming GA 30040
Agency Email:
Expiration Date: 2013-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
American Family Care
School of Nursing
Tina Patel
Phone: 205-271-5060
3700 Cahaba Beach Road
Birmingham AL 35242
Agency Email: tmpatel@americanfamilycare.com
Expiration Date: 2022-01-15
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 1/7/2021 - template sent to Legal for review. LYW

 
FOX Management Rehabilitation Services, LLC
Department of Physical Therapy
Richard Brown
Phone: 877-407-3422
7 Carnegie Plaza
Cherry Hill NJ 08003
Agency Email:
Expiration Date: 2024-08-31
Sent to Facility: 2015-11-12
Sent to Provost: 2017-04-20
Sent to Legal:
Completed: 2021-06-30
Requester Name: Carla Huggins
Document 1: Fox Rehabilitation
Document 2: FOX Management Rehabilitation Services, LLC_exp_8-31-2024
Document 3:
Comment: 11/27/18 when this comes up for renewal, see FOX Rehabilitation - OT, renewed November 2018. Covers all students. Contract uploaded.

 
Frye Regional Medical Center, LLC - NS, PT
Department of Physical Therapy
Sue LaBarge
Phone: 828-315-3186
420 North Center Street
Hickory NC 28601
Agency Email: Susan.Labarge@lpnt.net
Expiration Date: no expiration date
Sent to Facility: 2020-03-29
Sent to Provost: 2020-04-09
Sent to Legal: 2020-03-30
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: SARA JOHNSON, CONTRACT SPECIALIST, ADMINISTRATION Phone 828-315-3501 Sara.Johnson@LPNT.net 8/31/20 followed up with Kisha 9/2/20 Provost signed, to facility for final signature

 
Fulton County Housing and Human Services Department
Department of Nutrition
Sarah Hilton
Phone: 404-612-1243
137 Peactree Street, SW
Atlanta GA 30303
Agency Email: Sarah.Hilton@fultoncountyga.gov
Expiration Date: 2017-05-31
Sent to Facility: 2017-04-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: RENEWAL EMAILED.

 
Functional Improvements, Inc.
Department of Physical Therapy
Pamela Buttram
Phone: 770-979-3272
1003-B Oak Road, SW
Lilburn GA 30047
Agency Email:
Expiration Date: 2015-11-30
Sent to Facility: 2012-11-02
Sent to Provost: 2012-11-05
Sent to Legal:
Completed: 2012-11-19
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Functional Pathways
Department of Physical Therapy
Jennifer Anderson
Phone: 888-531-2204
614 Mabry Hood Road Suite 301
Knoxville TN 37932
Agency Email: j.anderson@fprehab.com
Expiration Date: 2022-09-30
Sent to Facility: 2019-05-23
Sent to Provost: 2019-06-13
Sent to Legal:
Completed: 2019-06-19
Requester Name: Carla Huggins
Document 1: Final Expires September 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Genesis ElderCare Rehabilitation Services, LLC d/b/a/ Genesis Rehab Services, LLC
Department of Physical Therapy and Occupational Therapy
Elizabeth Burke
Phone: 610-444-6350
101 East State Street
Kennett Square PA 19348
Agency Email: Elizabeth.Burke2@GenesisHCC.com
Expiration Date: 2021-11-30
Sent to Facility: 2020-03-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2: Exp Nov 2021 ...GenesisElderCare_Dec2018 FINAL
Document 3:
Comment: covers OT & PT Include ptclinicaleducation@gsu.edu on communication

 
Piedmont Newnan Hospital, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Jo Ann Mitchell
Phone: 770-254-3475
PO Box 997
Newnan GA 30264-0997
Agency Email:
Expiration Date: 2015-12-18
Sent to Facility: 2012-11-01
Sent to Provost: 2012-12-04
Sent to Legal:
Completed: 2012-12-18
Requester Name: Caroline Lombard
Document 1:
Document 2:
Document 3:
Comment: SEE PIEDMONT HEALTHCARE, INC

 
Pinewoods Crisis Stabilization Program
School of Nursing
Shirley Davison
Phone: 770-358-8371
700 Veterans Parkway
Barnesville GA 30204
Agency Email: sdavison@mctrail.org
Expiration Date: 2017-10-31
Sent to Facility: 2014-11-05
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-11-18
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Booker Poe Pediatrics
School of Nursing
Yolanda Coley
Phone: 404-691-3048
2600 Martin Luther King Jr. Blvd
Atlanta GA 30311
Agency Email: coleyyolanda@yahoo.com
Expiration Date: 2019-06-30
Sent to Facility: 2016-06-07
Sent to Provost: 2017-05-25
Sent to Legal:
Completed: 2017-06-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 6/27/2019 - this site is closed; the provider retired. LYW

 
Preferred Womens Healthcare
School of Nursing
Michael Runyan
Phone: 770-962-5100
500 Medical Center Boulevard Suite 290
Lawrenceville GA 30046
Agency Email:
Expiration Date: 2017-09-30
Sent to Facility: 2014-10-09
Sent to Provost: 2014-10-24
Sent to Legal:
Completed: 2014-11-03
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Premier Physical Therapy
Department of Physical Therapy
Linda Rotunda
Phone: 843-797-5167 ext101
2060 Northbrook Blvd Suite 101
North Charleston SC 29406
Agency Email: Linda@premierphysicaltherapy.us
Expiration Date: 2022-04-30
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-16
Sent to Legal:
Completed: 2019-04-17
Requester Name: Carla Huggins
Document 1: Final Expires April 2022
Document 2:
Document 3:

 
Georgia College & State University
School of Nursing
Judith Malachowski
Phone: 478-445-2633
CBX 064
Milledgeville GA 31061
Agency Email: judith.malachowski@gcsu.edu
Expiration Date: 2022-06-30
Sent to Facility:
Sent to Provost: 2018-11-07
Sent to Legal:
Completed: 2019-01-30
Requester Name: Paula Gordon
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: 10/22/18 Facility wishes to renew MOU. Will be sending agreement. 11/7/18 Sent to legal for review

 
Premier Physical Therapy and Sports Medicine
Department of Physical Therapy
Rose Tuggle
Phone: 770-389-9220
1035 Southcrest Drive Suite 130
Stockbridge GA 30281
Agency Email: swingate@comcast.net
Expiration Date:
Sent to Facility: 2015-01-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: MOU emailed

 
Presbyterian Village
Department of Nutrition
Pauline Chambers
Phone: 770-819-7000, x7406
2000 East-West Connector
Austell GA 30106
Agency Email:
Expiration Date: 2012-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Precision Rehab Occupational, Physical and Hand Therapy P.L.L.C.
Department of Occupational Therapy
John DiLorenzo
Phone: 718-380-8300
180-22 UNION TURNPIKE
FRESH MEADOWS N.Y 11366.
Agency Email: precisionrehabny@gmail.com
Expiration Date:
Sent to Facility: 2018-01-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: mou emailed

 
Hearts and Hands Therapy Services (Woodstock & McDonough)
Department of OccupationalTherapy
Amy Utecht
Phone: 1-844-543-8437
424 Creekstone Ridge
Woodstock GA 30188
Agency Email: amy@heartsandhandstherapy.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-16
Sent to Legal:
Completed: 2020-01-17
Requester Name: Shana Finks
Document 1: exp dec 2022 HeartsHandsTherapy_Jan2020.pdf
Document 2:
Document 3:
Comment: MOU should cover two locations: Hearts and Hands Therapy Services of Woodstock 424 Creekstone Ridge Woodstock, GA 30188 Hearts and Hands Therapy of McDonough 1350 Pennsylvania Avenue McDonough, GA 30253

 
Pro Performance Therapy, LLC
Department of Physical Therapy
Jacob Irwin
Phone: 770-663-6595
5245 Buford Hwy Suite 103-104
Norcross GA 30071
Agency Email: jake@properformancetherapy.com
Expiration Date: 2023-10-31
Sent to Facility: 2020-05-13
Sent to Provost: 2020-06-18
Sent to Legal:
Completed: 2020-07-29
Requester Name: Carla Huggins
Document 1: ExpOct2023 ProPerformance forProvost signed
Document 2:
Document 3:

 
Proaxis Therapy at Steadman Hawkins Clinic of the Carolinas
Department of Physical Therapy
Kristen Mason
Phone: 864-454-6670
727 SE Main Street Suite 200
Simpsonville SC 29681
Agency Email: wix@proaxistherapy.com
Expiration Date: 2013-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
Professional Health Services
Department of Physical Therapy
Suzanne Lawrence
Phone: (865) 474-7323
100 East Vine Street
Murfreesboro TN 37130
Agency Email: suzanne.lawrence@NHCcare.com
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-10-15
Requester Name: Carla Huggins
Document 1: Professional Health Services
Document 2:
Document 3:

 
Progressive Healthcare for Women
School of Nursing
Crystal Johnson
Phone: 770-339-4000
771 Old Norcross Road Suite 305
Lawrenceville GA 30046
Agency Email: crystal.johnson@unifiedhc.com
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
ProgressiveHealth Rehabilitation Solutions, Inc.
Department of Physical Therapy
Karyn Staples
Phone: 770-487-1931
1401 Georgian Park Suite 120
Peachtree City GA 30269
Agency Email: kstaples@phrehab.com
Expiration Date: 2023-10-31
Sent to Facility: 2020-05-13
Sent to Provost:
Sent to Legal:
Completed: 2020-12-23
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Name change to ProgressiveHealth Rehabilitation Solutions, Inc. Covers the following: •ProHealth Physical Therapy and Pilates Studio in Peachtree City, GA •ProgressiveHealth Rehabilitation in Griffin, GA

 
Open Hand Atlanta
Department of Nutrition
Laura Samnadda
Phone: 404-419-3331
181 Armour Drive
Atlanta GA 30324
Agency Email: lsamnadda@openhandatlanta.org
Expiration Date: 2023-09-30
Sent to Facility: 2020-04-29
Sent to Provost: 2020-07-30
Sent to Legal:
Completed: 2020-08-10
Requester Name: Jessica Todd
Document 1: ExpSep2023 OpenHandAtlanta July2020 signed pdf
Document 2:
Document 3:
Comment: non clinical

 
Providence Hospital
Department of Physical Therapy
Lane Mathis
Phone: 251-633-1436
6801 Airport Boulevard, Rehab Services PO Box 850429
Mobile AL 36608
Agency Email: lmathis@providencehospital.org
Expiration Date: 2023-06-01
Sent to Facility: 2020-02-18
Sent to Provost:
Sent to Legal: 2020-06-03
Completed: 2021-03-17
Requester Name: Carla Huggins
Document 1: Providence Hospital
Document 2:
Document 3:
Comment: Facility uses their own template 6/3/20 sent to legal for review

 
PT Solutions dba PT Solutions Holdings LLC
Department of Physical Therapy
Elizabeth Klein
Phone: 334-625-5805
6715 Taylor Court
Montgomery AL 36117
Agency Email: eklein@pt-solutions.us
Expiration Date: 2022-08-31
Sent to Facility: 2019-04-26
Sent to Provost: 2019-09-10
Sent to Legal:
Completed: 2019-09-16
Requester Name: Carla Huggins
Document 1: Final Expires August 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu 9/6/19 Elizabeth Klein: As previously discussed via email, all our contracts reflect PT Solutions Holdings LLC with our Practice Support Center address in Atlanta. The agreement will cover our entire Practice. 1100 Circle 75 Parkway, Suite 1400, Atlanta

 
Rainbow Community Center, Inc.
School of Nursing
Clara Lett
Phone: 770-787-8519
7133 Turner Lake Circle
Covington GA 30014
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Kenya Kirkendoll
Document 1: view
Document 2:
Document 3:

 
Georgia Cancer Specialists
School of Nursing
Jennifer Webster
Phone: 770-496-9426
1835 Savoy Drive Suite 300
Atlanta GA 30341
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-03-08
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:

 
Georgia Clinic, PC
BFLCNHP
Ina DSouza
Phone: 404-320-6050
2012 Harobi Drive Suite B
Tucker GA 30084
Agency Email: Lavistapc@bellsouth.net
Expiration Date: 2025-05-31
Sent to Facility: 2019-07-03
Sent to Provost:
Sent to Legal:
Completed: 2022-06-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Georgia Department of Early Care and Learning
Department of Nutrition
Monica Fink
Phone: 404-463-4093
10 Park Place South Suite 200
Atlanta GA 30303
Agency Email:
Expiration Date: 2013-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Georgia Department of Education
Department of Nutrition
Kelley Toon
Phone: 404-651-6600
205 Jesse Hill Jr Drive, SE 1662 Twin Tower East
Atlanta GA 30334
Agency Email: ktoon@doe.k12.ga.us
Expiration Date: 2023-05-31
Sent to Facility: 2020-06-08
Sent to Provost: 2020-06-15
Sent to Legal:
Completed: 2020-06-23
Requester Name: Jessica Todd
Document 1: ExpMay2023 Signed MOU GSU
Document 2:
Document 3:
Comment: non clinical Facility requested word version 6/8/20 Facility requests provost sign first 6/15/20, sent to provost 6/17/20 Provost signed, to facility for final signatures 6/29/20 Complete. Uploaded final

 
Georgia Family Care, LLC
School of Nursing
Rashmi Patel
Phone: 678-205-4999
2491 Panola Road
Lithonia GA 30058
Agency Email:
Expiration Date: 2019-01-31
Sent to Facility: 2016-01-15
Sent to Provost: 2016-01-21
Sent to Legal:
Completed: 2016-02-02
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:
Comment: 11/30/18 need email 12/5/18 on hold per Lisa Williams, facility not responding

 
Georgia Public Health District 2
Department of Nutrition
Charlene Thompson
Phone: 770-535-5875
1280 Athens Street
Gainesville GA 30507
Agency Email:
Expiration Date: 2016-12-31
Sent to Facility: 2013-12-10
Sent to Provost: 2013-12-17
Sent to Legal:
Completed: 2013-12-20
Requester Name:
Document 1:
Document 2:
Document 3:

 
Georgia Regional Hospital Atlanta
Byrdine F. Lewis School of Nursing & Health Professions
Donna Johnson
Phone: 404-212-4750
3073 Panthersville Road Building 13
Decatur GA 30034-3828
Agency Email: donna.johnson@dbhdd.ga.gov
Expiration Date: 2022-07-31
Sent to Facility: 2019-12-19
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2021-05-13
Requester Name: Anne Cadet
Document 1: exp feb 2021 ...213165119pdf
Document 2: Georgia Regional Hospital Atlanta_exp_07-31-21
Document 3:
Comment: 4/5/2022 requesting renewal

 
Forever Care Ob/Gyn
Byrdine F Lewis School of Nursing and Health Professions
Shirley Cau
Phone: 770-284-3099
3635 Peachtree Industrial Boulevard Suite 150
Duluth GA 30096
Agency Email: xcaumd@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2019-12-18
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...4122355.pdf
Document 2:
Document 3:

 
Georgia Rehabilitation Center
Department of Physical Therapy
Russ Foley
Phone: 770-254-7850
1755 E Hwy 34
Newnan GA 30265
Agency Email:
Expiration Date: 2015-12-31
Sent to Facility: 2012-11-06
Sent to Provost: 2012-11-20
Sent to Legal:
Completed: 2013-01-17
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: facilites at Summit Healthplex, Court Square, and Newnan Hospital

 
Rachel Brandeis LLC
Department of Nutrition
Rachel Brandeis
Phone: 770-752-4984
5555 Glenridge Ridge Connector Ste 200
Atlanta Ga 30342
Agency Email: rachel@rachelrd.com
Expiration Date: 2020-11-30
Sent to Facility: 2017-10-24
Sent to Provost: 2017-10-24
Sent to Legal:
Completed: 2017-10-27
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: complete

 
GGNSC Atlanta LLC
Department of Physical Therapy
Sharon Shinn
Phone: 770-591-6583
113 Jay Wood Drive
Woodstock GA 30188
Agency Email:
Expiration Date: 2012-03-31
Sent to Facility: 2012-01-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Golden Living Center-Northside #766 and AEGIS THERAPIES, INC, Requested agreement from clinical site; 1/30/12 email J Cline that the agreement has not been returned

 
Gilgal, Inc.
School of Nursing
Valerie Cater
Phone: 404-305-8007
PO Box 150777
Atlanta GA 30315-0777
Agency Email: val@womenofgilgal.org
Expiration Date: 2023-06-30
Sent to Facility: 2020-06-17
Sent to Provost: 2020-06-19
Sent to Legal:
Completed: 2020-06-23
Requester Name: Lisa Williams
Document 1: ExpJun2023 GilgalInc_forProvost - signed
Document 2:
Document 3:

 
Unified Premier Womens Care
School of Nursing
Mary Mead
Phone: 770-427-0285
574 Church Street
Marietta GA 30060
Agency Email: mary.mead@unifiedhc.com
Expiration Date: 2023-09-30
Sent to Facility: 2020-07-22
Sent to Provost: 2020-07-22
Sent to Legal:
Completed: 2020-08-10
Requester Name: Lisa Williams
Document 1: ExpSep2023 UnifiedPremierWC July2020 signed pdf
Document 2:
Document 3:
Comment: 8/12/20 Facility is only interested in Medical Assistants this fall. Told her we would/could reach out at later date

 
Glorified Health & Rehab
Department of Physical Therapy
Heather Burton
Phone: 864-295-1331
8 North Texas Road
Greenville SC 29611
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Good Samaritan Health Center
BFLCNHP
Breanna Lathrop
Phone: 678-553-4915
1015 Donald Lee Hollowell Pkwy
Atlanta GA 30318-6653
Agency Email: breanna@goodsamatlanta.org
Expiration Date: 2023-11-30
Sent to Facility: 2014-02-07
Sent to Provost: 2014-02-19
Sent to Legal:
Completed: 2014-03-06
Requester Name: Lisa Williams
Document 1: Good Samaritan Health Center_02-05-2021
Document 2:
Document 3:

 
Good Samaritan Health Center of Gwinnett
School of Nursing
Greg Lang
Phone: 678-280-6630, x107
3700 Club Drive
Lawrenceville GA 30044
Agency Email:
Expiration Date: 2016-10-31
Sent to Facility: 2013-10-15
Sent to Provost: 2013-10-24
Sent to Legal:
Completed: 2013-11-07
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Gordon Hospital
Byrdine F Lewis School of Nursing and Health Professions
Kathie Hartley
Phone: 706-879-4710
PO Box 12938
Calhoun GA 30703-7013
Agency Email: kathie.hartley@ahss.org
Expiration Date: 2022-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Joan Smith joan.smith@adventhealth.com (admin asst to Kathie Hartley)

 
Grow With Me Pediatric Therapy, Inc.
Department of Physical Therapy
Kelly Hidalgo
Phone: 770-345-2804
310 Paper Trail Way Suite 302
Canton GA 30115
Agency Email:
Expiration Date: 2015-03-31
Sent to Facility: 2011-11-21
Sent to Provost: 2011-11-30
Sent to Legal:
Completed: 2011-12-16
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Gwinnett County Board of Health
School of Nursing
Keisha Lewis-Brown
Phone: 678-442-6878
PO Box 897
Lawrenceville GA 30046-0897
Agency Email:
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: Left message for Ms. Lewis-Brown 4/7.

 
Gwinnett Emergency Specialists
School of Nursing
Jennifer Brooks
Phone: 678-312-3431
Learning Resources 100 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email:
Expiration Date: 2021-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: see Gwinnett Hospital System, MOU attached

 
Northeast Georgia Regional Education Services Agency
Department of Occupational Therapy
Marie Underwood
Phone: 706-742-8292 ext 226
375 Winter St.
Winterville Ga 30683
Agency Email: marie.underwood@negaresa.org
Expiration Date: 2020-12-31
Sent to Facility: 2020-09-02
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:

 
Gwinnett Health System, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Brooks
Phone: 678-312-3431
Learning Resources 100 Medical Center Boulevard, Suite 115
Lawrenceville GA 30046 -
Agency Email: Jbrooks@gwinnettmedicalcenter.org
Expiration Date: 2021-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Northside Hospital, Inc. has acquired Gwinnett Health System, Inc. Please copy Masiki Williamson on communication at ptclinicaleducation@gsu.edu. Thank you. MOU expires April 30, 2021 under Gwinnett Health Systems Inc. See file for included colleges & programs. Includes SummitRidge, Joan Glancy, Gwinnett Womens Pavillion, Mason Clinic, Kids Clinic, OB/GYN clinic, Wound Care Clinic,etc- includes associated physicians

 
We Care MD
BFLCNHP
Lisa Williams
Phone: 770-943-7808
5610 Wendy Bagel Parkway Suite 103
Hiram GA 30141
Agency Email: lisa.lynn@wecaremd.org
Expiration Date: 2021-06-30
Sent to Facility: 2018-06-19
Sent to Provost: 2018-06-22
Sent to Legal:
Completed: 2018-06-28
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment:

 
Gwinnett OB/GYN Associates, PC
School of Nursing
George Holland
Phone: 770-972-1836
1700 Tree Land Road Suite 290
Snellville GA 30078
Agency Email:
Expiration Date: 2013-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Gwinnett Pediatrics and Adolescent Medicine
School of Nursing
Debbie Maund
Phone: 770-995-0823
2089 Teron Trace Suite 100
Dacula GA 30019
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Will not renew at this time only taking residents now.

 
Gwinnett Rockdale Newton Community Service Board
School of Nursing
Melissa Knight
Phone: 770-339-5377
175 Gwinnett Drive, Business Office 271 PO Box 687
Lawrenceville GA 30046-0687
Agency Email:
Expiration Date: 2013-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Joan Bacon
Document 1:
Document 2:
Document 3:

 
Gynecology & Obstetrics Professional Group of West Georgia
School of Nursing
Brandi Knox
Phone: 706-884-6026
1602 Vernon Road Suite 200
LaGrange GA 30240
Agency Email: brandi212@lagrangewomenshealth.net
Expiration Date: 2018-08-31
Sent to Facility: 2015-08-24
Sent to Provost: 2015-09-02
Sent to Legal:
Completed: 2015-09-11
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Habersham County Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Elizabeth Smith
Phone: 706-754-0029
P O Box 37 Rehab Services Department
Demorest GA 30535
Agency Email: elizabeth.smith@hcmcmed.org
Expiration Date: 2025-03-31
Sent to Facility: 2019-03-28
Sent to Provost: 2019-04-18
Sent to Legal:
Completed: 2022-03-14
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Harbin Clinic
BFLCNHP
Tonya West
Phone: 762-235-1191
221 Technology Parkway
Rome GA 30165
Agency Email: tonya.west@HarbinClinic.com
Expiration Date: 2024-03-31
Sent to Facility: 2017-11-03
Sent to Provost: 2017-11-14
Sent to Legal:
Completed: 2021-06-07
Requester Name: Lisa Williams
Document 1: Harbin Clinic_exp_03-31-2024
Document 2:
Document 3:
Comment: Influenza vaccination Addendum in file folder. Covers all Harbin Locations. Includes edits from site. GSU standard template was modified-06-04-2021

 
Dr. Harry R Foster, Jr, MD, PA
School of Nursing
Emily Foster
Phone: 770-482-8887
7660 Covington Highway
Lithonia GA 30058
Agency Email:
Expiration Date: 2017-02-28
Sent to Facility: 2014-02-26
Sent to Provost: 2014-02-28
Sent to Legal:
Completed: 2014-03-12
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
HCR Healthcare, LLC
Department of Physical Therapy
Ellen Perlow
Phone: 419-254-7814
333 N Summit St
Toledo OH 43604
Agency Email: 614rehab@hcr-manorcare.comcom
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: 614rehab@hcr-manorcare.comcom undeliverable

 
Health Connection, Inc.
School of Nursing
Twilla Haynes
Phone: 706-367-7302
657 Athens Street
Jefferson GA 30549
Agency Email: thaynes123@aol.com
Expiration Date: 2019-03-31
Sent to Facility: 2015-11-24
Sent to Provost: 2015-12-08
Sent to Legal:
Completed: 2015-12-16
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: Paulester, We will have a student at this site for spring so need contract renewed to cover whole clinical period. Thx. SN

 
Encompass Health Corporation
Byrdine F Lewis School of Nursing and Health Professions
Angela Shook
Phone: 205-970-5595
Corporate Human Resources 3660 Grandview Parkway, Suite 200
Birmingham AL 35216
Agency Email: angela.shook@encompasshealth.com
Expiration Date: 2020-02-29
Sent to Facility: 2019-10-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: NEW process for Encompass Health: As national agreements expire, they will be replaced with a hospital specific agreement listing only the hospital where the student(s) will be placed. It will auto renew each year, so even though you may now have to sign multiple agreements if you send students to more than one hospital, they will not have the three year term like the national agreements. Once it is signed with a hospital, it will remain in place unless you or the hospital deem it necessary to terminate it.

 
Highland Urgent Care and Family Medicine
School of Nursing
Nick Beaulieu
Phone: 404-815-1957
920 Ponce de Leon Avenue
Atlanta GA 30306-4212
Agency Email: info@hucfm.com
Expiration Date: 2019-11-30
Sent to Facility: 2016-04-30
Sent to Provost: 2016-05-05
Sent to Legal:
Completed: 2016-05-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Hi-Tech Healthcare, Inc.
Department of Respiratory Therapy
Todd Tyson
Phone: (770) 449-6785
1805 Shackleford Court Suite 100
Norcross GA 30093
Agency Email: ttyson@hitechntcmail.net
Expiration Date: 2017-02-28
Sent to Facility: 2014-03-13
Sent to Provost: 2014-03-25
Sent to Legal:
Completed: 2014-04-10
Requester Name: Doug Gardenhire
Document 1:
Document 2:
Document 3:

 
Friendship Center Inc (The)
BFLCNHP
Tameka Baker
Phone: 404-627-6510
Holy Comforter Church 737 Woodland Avenue, SE
Atlanta GA 30316
Agency Email: executivedirector@friendshipcenter-atlanta.org
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 201-11-04
Requester Name: Lisa Williams
Document 1: The Friendship Center Inc
Document 2:
Document 3:
Comment: The Friendship Center at Holy Comforter

 
Hope for Kids
School of Nursing
Arthur Provisor
Phone: 478-633-2694
770 Pine Street Suite 520
Macon GA 31201
Agency Email:
Expiration Date: 2014-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1:
Document 2:
Document 3:

 
Hornsby Rehabilitation Services
Department of Physical Therapy
Annie Hornsby
Phone: 828-369-7878
235 Jim Berry Road
Franklin NC 28734
Agency Email:
Expiration Date: 2015-03-31
Sent to Facility: 2011-11-21
Sent to Provost: 2011-02-02
Sent to Legal:
Completed: 2011-02-16
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: HealthWorks

 
Houston Family Medicine and Urgent Care
School of Nursing
Dorothy Felton
Phone: 478-988-1282
106 Moran Drive
Bonaire GA 31005
Agency Email:
Expiration Date: 2013-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sybert
Document 1: view
Document 2:
Document 3:

 
Houston Hospitals,INC d/b/a Houston Medical Center, Pavilion Rehab
Byrdine F Lewis School of Nursing and Health Professions
Cindy Watson
Phone: 478-975-6740
Organizational Development 1601 Watson Blvd
Warner Robins GA 31093
Agency Email: tclark@hhc.org
Expiration Date: 2023-10-31
Sent to Facility: 2018-01-11
Sent to Provost: 2018-02-14
Sent to Legal:
Completed: 2020-10-31
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Houston Medical Center, Perry Hospital and Pavilion Rehab complete

 
Hughes Spalding of Children's
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Bay
Phone: 404-785-7640
Childrens Healthcare of Atlanta 1600 Tullie Circle
Atlanta GA 30329
Agency Email: jenniferbay@choa.org
Expiration Date: 2015-04-30
Sent to Facility: 2012-03-08
Sent to Provost: 2012-03-22
Sent to Legal:
Completed: 2012-04-19
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Hughes Spalding/ Managed by CHOA

 
HUG, Inc.
School of Nursing
Anicia Bigelow
Phone: 404-518-3790
390 17th Street # 2020
Atlanta GA 30363
Agency Email: Charlie@huginc.comcastbiz.net
Expiration Date: 2017-06-30
Sent to Facility: 2014-06-09
Sent to Provost: 2014-09-18
Sent to Legal:
Completed: 2014-10-01
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Hughston Hospital, dba Northside Medical Center
Department of Physical Therapy & Occupational Therapy
Susan Kulakowski
Phone: 706-494-2466
100 Frist Court
Columbus GA 31906
Agency Email: Susan.Kuakowski@columbusregional.com
Expiration Date:
Sent to Facility: 2015-10-23
Sent to Provost: 2016-01-21
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Human Performance and Rehabilitation Centers, Inc.
Department of Physical Therapy
Lynn McCluskey
Phone: (706) -322-7762
PO Box 8068
Columbus GA 31908-8068
Agency Email: lmccluskey@hprc.net
Expiration Date: 2019-08-31
Sent to Facility: 2019-03-29
Sent to Provost: 2019-06-18
Sent to Legal:
Completed: 2019-11-18
Requester Name: Carla Huggins
Document 1: Exp March 2022 ...105338pdf
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Intown Atlanta Psychiatry
BFLCNHP
Elizabeth Robinson
Phone: 404-539-0719
289 Little Street
Atlanta GA 30315
Agency Email: intownatlpsych@hotmail.com
Expiration Date: 2025-02-28
Sent to Facility: 2020-09-15
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:

 
Internal Medicine Alliance, LLC
School of Nursing
Amra Zecic
Phone: 678-495-2100, x228
2179 Northlake Parkway Building 5, Suite 101
Tucker GA 30084
Agency Email:
Expiration Date: 2015-11-30
Sent to Facility: 2012-11-20
Sent to Provost: 2012-11-26
Sent to Legal:
Completed: 2012-12-10
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Internal Medicine Specialists, PC
School of Nursing
Spencer Rozin
Phone: 770-709-0900
721 Wellness Way Suite 220
Lawrenceville GA 30046
Agency Email:
Expiration Date: 2014-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Intown Midwifery
School of Nursing
Margaret Stickhouser
Phone: 404-622-9810
340 Boulevard NE Suite 103
Atlanta GA 30312
Agency Email: info@intownmidwifery.com
Expiration Date: 2019-07-31
Sent to Facility: 2019-07-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/9/19 Does not wish to renew due to low volume. Midwifery students are their priority.

 
Intown Pediatric and Adolescent Medicine, PC
School of Nursing
Teresa Andrews
Phone: 404-446-4726
490 Bill Kennedy Way Suite 101
Atlanta GA 30316
Agency Email: teresa@intownpediatrics.com
Expiration Date: 2022-10-31
Sent to Facility: 2019-07-01
Sent to Provost: 2019-07-02
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires October 2022
Document 2:
Document 3:
Comment: Please renew.

 
Intown Primary Care
School of Nursing
Shanitra Holloway
Phone: 404-541-0944
730 Ponce de Leon Place
Atlanta GA 30306-4287
Agency Email: intownprimary@yahoo.com
Expiration Date: 2019-12-31
Sent to Facility: 2016-11-08
Sent to Provost: 2016-12-01
Sent to Legal:
Completed: 2016-12-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
ISAC (India Study Abroad Center)
Department of Nutrition
Hansal Mehta
Phone: 91-9833-966114
New Link Road, Oshiwara Suite 311, Reliable Pride
Mumbai Maharashtra 400 053
Agency Email:
Expiration Date: 2013-10-21
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-03-11
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: India Study Abroad Center

 
Jackson Hospital & Clinic, Inc.
Department of Physical Therapy
Jason Fogg
Phone: 334-293-8158
1725 Pine Street South Building Therapy Annex
Montgomery AL 36106
Agency Email:
Expiration Date: 2015-09-30
Sent to Facility: 2012-09-13
Sent to Provost: 2012-10-09
Sent to Legal:
Completed: 2012-10-17
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Dr. Jean Joseph Philippe, MD, PC
School of Nursing
Jean Joseph Philippe
Phone: 404-748-9006
315 Boulevard, NE Suite 528
Atlanta GA 30312
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Jewish Federation of Greater Atlanta
Department of Nutrition
Janie Walker
Phone: 404-870-1638
1440 Spring Street NW
Atlanta GA 30309
Agency Email: jwalker@jfga.org
Expiration Date: 2019-08-31
Sent to Facility: 2016-08-17
Sent to Provost: 2016-08-29
Sent to Legal:
Completed: 2016-08-30
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Fulton County Schools
Department of Physical Therapy
Nancy Erickson
Phone: 470-254-3600
6201 Powers Ferry Rd FCS Administrative Center
Atlanta GA 30339
Agency Email:
Expiration Date: 2024-07-31
Sent to Facility: 2019-11-15
Sent to Provost:
Sent to Legal:
Completed: 2021-12-09
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy Debbie Betts PT, DPT: BettsD@fultonschools.org Copy ptclinicaleducation@gsu.edu

 
John D Archbold Memorial Hospital
Byrdine F Lewis School of Nursing and Health Professions
Donna C. McMillan
Phone: 229-228-2821
PO Box 1018 3 East
Thomasville GA 31799-1018
Agency Email: dmcmillan@archbold.org
Expiration Date: 2022-12-31
Sent to Facility: 2018-03-08
Sent to Provost: 2018-04-09
Sent to Legal:
Completed: 2018-04-19
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: complete

 
Johns Creek Physical Therapy, LLC
Department of Physical Therapy
Marc Stewart
Phone: 770-622-5344
4255 Johns Creek Parkway Suite A
Suwanee GA 30024-6038
Agency Email: mstewart44@hotmail.com
Expiration Date: 2020-02-28
Sent to Facility: 2019-10-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Johns Creek Primary Care Physicians, LLC
BFLCNHP
Lee Urbanski
Phone: 678-957-1910
4365 Johns Creek Parkway Suite 400
Suwanee GA 30024
Agency Email: lee_jcpc@yahoo.com
Expiration Date: 2019-11-30
Sent to Facility: 2016-08-19
Sent to Provost: 2016-08-19
Sent to Legal:
Completed: 2016-08-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
JW Medical & Dental Consulting
School of Nursing
L Flowers
Phone: 678-252-2137
2220 Wisteria Drive Suite 208
Snellville GA 30078
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Kaiser Foundation Health Plan, Inc. and The Southeast Permanente Medical Group, Inc.
Byrdine F Lewis College of Nursing and Health Professions - School of Nursing
Shawn Willis
Phone: 404-364-7099
Nine Piedmont Center 3495 Piedmont Road, NE
Atlanta GA 30305-1736
Agency Email: donna.doetsch@kp.org
Expiration Date: 2022-08-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1: BOR Agreement Expires July 2020
Document 2: Nursing Addendum Exp May 31 2020
Document 3: ExpAug2021 GSU_BOR_AA_ Attachment B_v2 - fully executed

 
Kid Care Pediatrics
School of Nursing
Wil Daniels
Phone: 404-765-9437
2565 Jolly Road Suite A
College Park GA 30349
Agency Email:
Expiration Date: 2016-04-30
Sent to Facility: 2013-05-01
Sent to Provost: 2013-05-15
Sent to Legal:
Completed: 2013-06-26
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Kids and Teens Primary Healthcare
BFLCNHP
Lynette Morrisey
Phone: 770-621-0245
2785 Lawrenceville Highway Suite 207
Decatur GA 30033
Agency Email: lynette@ktphc.com
Expiration Date: 2021-03-31
Sent to Facility: 2018-03-21
Sent to Provost: 2018-04-12
Sent to Legal:
Completed: 2018-04-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Kids First Pediatric Group, LLC
BFLCNHP
Anika Potts
Phone: 770-507-2212
1045 Southcrest Drive Suite 110
Stockbridge GA 30281
Agency Email: apotts@kidsfirstped.com
Expiration Date: 2021-06-30
Sent to Facility: 2018-06-01
Sent to Provost: 2018-09-13
Sent to Legal:
Completed: 2018-09-27
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
La Clinica del Nino, PC
School of Nursing
Betsy Roberts
Phone: 770-263-9101
3780 Holcomb Bridge Road Suite C
Norcross GA 30092
Agency Email:
Expiration Date: 2016-12-31
Sent to Facility: 2014-01-14
Sent to Provost: 2014-01-19
Sent to Legal:
Completed: 2014-01-24
Requester Name: Regena Spratling
Document 1: view
Document 2:
Document 3:
Comment: Clinica Internacional de Pediatria, Student must speak Spanish

 
LaGrange Pediatrics
School of Nursing
Patsy Johnson
Phone: 706-883-6363
1527 Vernon Road
LaGrange GA 30240
Agency Email:
Expiration Date: 2017-02-28
Sent to Facility: 2014-03-04
Sent to Provost: 2014-03-04
Sent to Legal:
Completed: 2014-03-12
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Laureate Medical Group
Department of Nutrition
Cheryl Orlansky
Phone: 678-781-3021
550 Peachtree Street Suite 1550
Atlanta GA 30308
Agency Email:
Expiration Date: 10-4-22
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: clinical renewal

 
Georgia Institute of Technology Health Initiatives
Department of Nutrition
Danielle Southern
Phone: 4048943710
740 Ferst Dr. NW Suite 232
Atlanta GA 30332
Agency Email: danielle.southern@health.gatech.edu
Expiration Date:
Sent to Facility: 2019-09-13
Sent to Provost: 2019-08-19
Sent to Legal: 2019-07-24
Completed: 2022-27-05
Requester Name: Jessica Todd
Document 1: Final Expires July 2022 - Clinical AND Non-Clinical
Document 2:
Document 3:
Comment: Non Clincial Renewal

 
Henry County Schools
Department of Nutrition
Kantrell Brown
Phone: 770-914-0815 ext 808
396 Tomlinson Street
McDonough Georgia 30253
Agency Email: kantrell.brown@henry.k12.ga.us
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-07
Sent to Provost: 2018-01-04
Sent to Legal:
Completed: 2018-01-18
Requester Name: jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non-clinical agreement

 
Madison Family Medicine
School of Nursing
Walter Zant Jr.
Phone: 706-342-1555
2002 South Main Street
Madison GA 30650
Agency Email: jphilippi@madisonfamilymedicine.com
Expiration Date: 2019-04-30
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Lifeboat Medical Associates
School of Nursing
Amanda Joiner
Phone: 770-631-4873
1201 Georgian Park
Peachtree City GA 30269
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-05-24
Sent to Provost: 2013-06-04
Sent to Legal:
Completed: 2013-07-30
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Lifetime Family Medicine
School of Nursing
Erin Costanzo
Phone: 770-459-8449
7869 Villa Rica Highway
Dallas GA 30157
Agency Email:
Expiration Date: 2013-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1: view
Document 2:
Document 3:

 
Lisa D Miller Pediatrics, PC
School of Nursing
Lisa Miller
Phone: 770-788-1077
4152 Baker Street, NE
Covington GA 30014
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1: view
Document 2:
Document 3:

 
Locust Grove Pediatrics
BFLCNHP
Deborah Wellborn
Phone: 678-583-5437
5040 Bill Gardner Parkway Suite 100
Locust Grove GA 30248
Agency Email: deborah@lgp.pcc.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-07
Sent to Provost: 2017-11-08
Sent to Legal:
Completed: 2017-11-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Loganville Family Medicine
School of Nursing
Pam Cassara
Phone: 770-466-8672
4589 Lawrenceville Road
Loganville GA 30052
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:

 
Lukes Place
School of Nursing
Donna Pennington
Phone: 770-312-3159
948 Front Street
Mableton GA 30126
Agency Email: domapen@hotmail.com
Expiration Date: 2021-07-31
Sent to Facility: 2018-07-12
Sent to Provost:
Sent to Legal:
Completed: 2018-08-15
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 7/12/18 MOU emailed to D. Pennington 8/17/18 Complete. emailed to all parties

 
Manual Therapy International
Department of Physical Therapy
Cindy Unsleber
Phone: 206-839-4780
1325 6th Avenue PO Box 1709
Seattle WA 98111
Agency Email: cindyunsleber@mtipt.com
Expiration Date: 2017-10-31
Sent to Facility: 2017-04-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
Marietta OB/GYN Affiliates, PA
School of Nursing
Marilyn Smolinski
Phone: (770) 422-8509, x118
625 Church Street, NE
Marietta GA 30060
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Hewell
Document 1:
Document 2:
Document 3:

 
Martin Army Community Hospital
School of Nursing
Yolanda Wilson
Phone: (706) 544-1556
Martin Army Community Hospital
Fort Benning GA 31905
Agency Email:
Expiration Date: 2017-04-02
Sent to Facility: 2007-07-23
Sent to Provost: 2008-01-08
Sent to Legal:
Completed: 2008-04-02
Requester Name: Gingras
Document 1:
Document 2:
Document 3:
Comment: no termination date

 
Mason Primary Care
School of Nursing
Sandra Mason
Phone: 770-476-3636
3500 McClure Bridge Road
Duluth GA 30096
Agency Email:
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-13
Sent to Provost: 2014-08-22
Sent to Legal:
Completed: 2014-08-29
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
McDonough Primary Care, Inc.
School of Nursing
Jody Pesce
Phone: 770-914-0342
68 Hampton Street
McDonough GA 30253
Agency Email:
Expiration Date: 2015-07-31
Sent to Facility: 2012-07-13
Sent to Provost: 2012-07-16
Sent to Legal:
Completed: 2012-07-23
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
McIntosh Trail Early Childhood Development Center
School of Nursing
Nellie McKibben
Phone: 770-775-4295, x208
565 Recreation Drive
Jackson GA 30233
Agency Email:
Expiration Date: 2012-09-30
Sent to Facility: 2012-06-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Kenya Kirkendoll
Document 1: view
Document 2:
Document 3:

 
McIntosh Trail Family Practice
School of Nursing
Wendy Parrish
Phone: 678-851-3610
747 South Hill Street
Griffin GA 30224
Agency Email:
Expiration Date: 2013-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Thomas
Document 1:
Document 2:
Document 3:

 
Med South Primary Care
School of Nursing
Karen Robinson
Phone: 678-508-1617
100 Eagles Walk Suite A
Stockbridge GA 30281
Agency Email: medsouth@bellsouth.net
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-31
Sent to Provost: 2014-02-26
Sent to Legal:
Completed: 2014-03-12
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Augusta University Medical Center
Department of Physical Therapy,Resipatory Therapy & Occupational Therapy
Celeste Ray
Phone: 706-721-2482
MCG Health System, Rehabilitation Services Department 1120 15th Street, BIW-6045
Augusta GA 30912-6200
Agency Email: cray@augusta.edu
Expiration Date: 2025-06-09
Sent to Facility: 2020-08-10
Sent to Provost: 2020-07-13
Sent to Legal: 2020-07-08
Completed: 2020-08-13
Requester Name: Carla Huggins
Document 1: ExpJun2025 Georgia State GSU PT OT
Document 2: Augusta University Medical Center - Nursing
Document 3:

 
Medical College of Georgia Health, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Celeste Ray
Phone: 706-721-2482
MCG Health Systemdba Georgia Regents Medical Center 1120 15th Street, Biw-6045
Augusta GA 30912-6200
Agency Email:
Expiration Date: 2016-06-30
Sent to Facility: 2016-04-12
Sent to Provost: 2016-05-17
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Sent to facility for signature 5/18/16.

 
Metro Atlanta YMCA
Department of Nutrition
Nicky Rosenbluth
Phone: 404-267-5337
100 Edgewood Avenue, NE Suite 1100
Atlanta GA 30303-3065
Agency Email:
Expiration Date: 2016-06-30
Sent to Facility: 2013-06-18
Sent to Provost: 2013-06-19
Sent to Legal:
Completed: 2013-06-26
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Food Bank of Northeast Georgia
Department of Nutrition
Cara-Lee Langston
Phone: 706-782-0780
46 plaza way
clayton Ga
Agency Email: teachingkitchen.mtn@foodbanknega.org
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-19
Sent to Provost: 2018-01-25
Sent to Legal:
Completed: 2018-02-01
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement complete

 
Mid Coast Hospital
Department of Physical Therapy
Jennifer Anderson
Phone: 207-373-6175
123 Medical Center Drive Rehabilitation Services
Brunswick ME 04011
Agency Email: jwolfe@midcoasthealth.com
Expiration Date: 2019-03-31
Sent to Facility: 2019-03-29
Sent to Provost: 2019-04-11
Sent to Legal:
Completed: 2019-04-17
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Midtown West Medical at King Plow Arts Center
School of Nursing
Gloria J Carusi
Phone: 404-873-3809
957 W Marietta Street, NW
Atlanta GA 30318-5215
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Columbia Basin Health Association
Byrdine F Lewis School of Nursing and Health Professions
Devyn Lynch
Phone: 509-488-5253
1515 Columbia Street
Othello WA 99344
Agency Email: DulcyeF@cbha.org
Expiration Date: 2022-05-31
Sent to Facility: 2019-05-23
Sent to Provost:
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: send final to Devyn Lynch (devynl@cbha.org) and Gina Saldana (ginas@cbha.org) –

 
Montreal Internal Medicine Associates, PC
School of Nursing
Rita Williams
Phone: 770-938-9761
Montreal Medical Center 1462 Montreal Road, Suite 303
Tucker GA 30084
Agency Email:
Expiration Date: 2012-11-30
Sent to Facility: 2012-11-02
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:

 
Mountain East Family Medicine, PC
School of Nursing
Kelley Wharton
Phone: 770-921-6900
4120 Five Forks Trickum Road Sutie 105
Lilburn GA 30047
Agency Email:
Expiration Date: 2015-12-31
Sent to Facility: 2012-12-10
Sent to Provost: 2012-12-17
Sent to Legal:
Completed: 2013-01-21
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Covered by Dekalb Regional Health System

 
Mountain States Health Alliance
Department of Physical Therapy
Sandra Sims
Phone: 423-952-1717
Organizational Development 1106 West Market Street
Johnson City TN 37601
Agency Email:
Expiration Date: 2019-02-24
Sent to Facility: 2013-09-26
Sent to Provost: 2013-11-05
Sent to Legal:
Completed: 2013-12-19
Requester Name: Carla Huggins
Document 1:
Document 2: Term Letter Effective Feb 24 2019
Document 3:
Comment: Either Patrty May Terminate With 30 Day Notice

 
Nature Coast Rehabilitation, Inc.
Department of Physical Therapy
Beth Hicks
Phone: 352-514-6391
1315 NW 21st Avenue Suite 3
Chiefland FL 32626
Agency Email:
Expiration Date: 2015-03-31
Sent to Facility: 2011-11-21
Sent to Provost: 2011-11-30
Sent to Legal:
Completed: 2011-12-16
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Neuro-Developmental Treatment Programs, Inc.
Department of Physical Therapy
Judy Bierman
Phone: 706-736-1255
817 Crawford Avenue
Augusta GA 30904
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-09-26
Sent to Provost: 2013-10-04
Sent to Legal:
Completed: 2013-10-22
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Neuropsychiatric Clinic of Atlantis-Villa Rica PC
School of Nursing
Tiffany Wimpey
Phone: 678-840-8446
690 Dallas Highway Suite 201
Villa Rica GA 30180
Agency Email:
Expiration Date: 2016-09-30
Sent to Facility: 2013-08-09
Sent to Provost: 2013-08-12
Sent to Legal:
Completed: 2013-09-04
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Neurosport Physical Therapy
Department of Physical Therapy
Laura Baeumel
Phone: 404-504-9030
3365 Piedmont Road Suite 1260
Atlanta GA 30305
Agency Email: lcozzo@neurotour.com
Expiration Date: 2022-01-31
Sent to Facility: 2018-11-27
Sent to Provost: 2019-04-30
Sent to Legal:
Completed: 2019-05-09
Requester Name: Carla Huggins
Document 1: Renewal Letter Expires January 2022
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
New Beginnings OB/GYN, Inc.
School of Nursing
Deborah Wallace
Phone: 770-229-1117
231 B West College Street
Griffin GA 30224
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-09-05
Sent to Provost: 2013-09-10
Sent to Legal:
Completed: 2013-09-18
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
New Millennium Obstetrics & Gynecology
School of Nursing
Rosa Gomez
Phone: 770-991-0778
83 Upper Riverdale Road Suite 135
Riverdale GA 30274
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-02-06
Sent to Provost: 2012-02-12
Sent to Legal:
Completed: 2013-02-27
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Newton Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Valorie Patrick
Phone: 770-786-7053
5126 Hospital Drive, NE
Covington GA 30014
Agency Email: jdial@newtonmedical.com
Expiration Date: 2017-03-31
Sent to Facility: 2013-03-12
Sent to Provost: 2014-03-19
Sent to Legal:
Completed: 2014-04-10
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: NOW PART OF PIEDMONT HEALTHCARE, INC. Amendment sent to Legal for Provost signature 11/13/15.

 
North Fork Rehabilitation, Inc.
Department of Physical Therapy
Joseph Sansom
Phone:
88 Industrial Drive Road
Brookville PA 15825
Agency Email:
Expiration Date: 2014-12-31
Sent to Facility: 2011-11-16
Sent to Provost: 2011-11-22
Sent to Legal:
Completed: 2011-12-16
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
North Fulton Medical Center, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Yvelina Rasado
Phone: (770) 751-2780
3000 Hospital Boulevard
Roswell GA 30076
Agency Email: yvelina.rosado@tenethealth.com
Expiration Date: 2018-12-31
Sent to Facility: 2015-11-02
Sent to Provost: 2015-11-16
Sent to Legal:
Completed: 2015-11-30
Requester Name: JoAnn Bacon
Document 1:
Document 2:
Document 3:
Comment: North Fulton Regional Hospital, Tenet HealthSystem;

 
North Fulton Pediatrics, PC
BFLCNHP
Leigh Anne Bearden
Phone: 770-442-1050
1285 Hembree Road Suite 100
Roswell GA 30076
Agency Email: lbearden@northfultonpediatrics.com
Expiration Date: 2024-06-30
Sent to Facility: 2018-07-06
Sent to Provost: 2018-07-10
Sent to Legal:
Completed: 2021-05-12
Requester Name: Lisa Williams
Document 1: North Fulton Pediatrics PC_exp_06-30-24
Document 2:
Document 3:

 
North Fulton Physical Therapy and Sports Medicine, Inc.
Department of Physical Therapy
David Young
Phone: 770-442-0727
1355 Hembree Road
Roswell GA 30076
Agency Email: nfultonpt@turbopt.com
Expiration Date: 2020-02-28
Sent to Facility: 2019-10-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Northeast Georgia Medical Center
Department of Physical Therapy, OT
Haylee Gamble
Phone: 770-219-6287
Educatonal Services Dept.
Gainesville GA 30501
Agency Email: mellypt@hotmail.com
Expiration Date: 2022-05-06
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires May2022 ..NE GA MED CENTERpdf
Document 2: Northeast Georgia Amendment
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu sent partially executed agreement on 3-14-2022

 
Northeast Health District
BFLCNHP
Whitney Howell
Phone: 706-583-2777
220 Research Drive
Athens GA 30605
Agency Email: Whitney.Howell@dph.ga.gov>
Expiration Date: 2024-02-29
Sent to Facility: 2018-02-22
Sent to Provost: 2018-02-27
Sent to Legal:
Completed: 2021-07-06
Requester Name: Lisa Williams
Document 1: Northeast Health District
Document 2:
Document 3:
Comment: includes Barrow, Clarke, Elbert, Greene, Jackson, Oglethorpe, Walton, Madison, Morgan, and Oconee

 
Northlake Internal Medicine
School of Nursing
Shiley Banks
Phone: 770-496-2929
2175 Northlake Parkway Building 4, Suite 142
Tucker GA 30084
Agency Email:
Expiration Date: 2012-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Keiser
Document 1: view
Document 2:
Document 3:

 
Porter Academy
Department of Occupational Therapy
Lynn Schoeneck
Phone: 7705941313 ext 230
200 Cox Rd
Roswell Ga. 30075
Agency Email: lschoeneck@porteracademy.org
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-28
Sent to Provost: 2017-12-05
Sent to Legal:
Completed: 2017-12-12
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:

 
Northside Hospital, Inc.
Byrdine F Lewis College of Nursing and Health Professions
Marsha Blakey
Phone: 404-236-8078
1000 Johnson Ferry Road Building C-Suite 240
Atlanta GA 30342
Agency Email: Marsha.Blakey@Northside.com
Expiration Date: 2024-03-18
Sent to Facility: 2019-08-22
Sent to Provost: 2019-06-27
Sent to Legal: 2019-05-20
Completed: 2021-04-07
Requester Name: Kelli Nowviskie
Document 1: Final Expires October 4 2022
Document 2: Final Expires October 4 2022
Document 3: exp oct 2022 ...northside hosp dnp ammen pdf
Comment: Partially executed 4-08-2021 Covers ALL Lewis College programs as listed in addendum. 9/30/19 DNP Addendum to provost for signature per C. Lombard Blakey wants original mailed when completed.

 
Lenbrook
Department of Nutrition
Steven West
Phone: 404-262-3397
3747 Peachtree Road NE
Atlanta Georgia 30329
Agency Email: swest@lenbrook-atlanta.com
Expiration Date: 2020-10-31
Sent to Facility: 2017-10-10
Sent to Provost: 2017-10-24
Sent to Legal:
Completed: 2017-10-27
Requester Name: jessica todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical agreement complete

 
Northwest Women's Care
School of Nursing
Maria Rivera
Phone: 770-528-0260
787 Campbell Hill Street
Marietta GA 30063
Agency Email:
Expiration Date: 2016-08-27
Sent to Facility: 2013-06-01
Sent to Provost: 2013-07-30
Sent to Legal:
Completed: 2013-08-27
Requester Name:
Document 1:
Document 2:
Document 3:
Comment: see Wellstar Health System

 
North Macon Family Healthcare Associates
BFLCNHP
Autumn Canady
Phone: 478-471-0089
540 Charter Boulevard Suite 100
Macon GA 31210
Agency Email: autumn@northmaconfha.com
Expiration Date: 2025-12-31
Sent to Facility: 2017-12-13
Sent to Provost: 2017-12-08
Sent to Legal:
Completed: 2021-11-23
Requester Name: Lisa Williams
Document 1: North Macon Family Healthcare Associates
Document 2:
Document 3:
Comment: complete

 
Obstetrics and Gynecology of Atlanta, LLC
School of Nursing
Kelly Brannam
Phone: 404-252-1137
1100 Johnson Ferry Road, NE Suite 800
Atlanta GA 30342
Agency Email: kbrannam@awhg.org
Expiration Date: 2024-10-31
Sent to Facility: 2013-09-26
Sent to Provost: 2013-09-26
Sent to Legal:
Completed: 2021-12-10
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
Oconee Regional Health Systems, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Marlena Waddell
Phone: 478-454-3505
P. O. Box 690 821 North Cobb Street
Milledgeville GA 31059
Agency Email: mwaddell@ormcinc.org
Expiration Date: 2017-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Ortho Sport Physical Therapy
Department of Physical Therapy
Julie Scott
Phone: 229-883-8914
619 Point North Boulevard
Albany GA 31721
Agency Email: orthosport@albones.com
Expiration Date: 2016-06-30
Sent to Facility: 2015-11-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: COVERED UNDER WELLSTAR MOU.

 
OrthoSport Physical Therapy
Department of Physical Therapy
Niki Groves
Phone: 770-974-7494
3450 Acworth Due West Road Suite 310
Kennesaw GA 30144
Agency Email: niki.groves@wellstar.org
Expiration Date:
Sent to Facility: 2015-11-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: MOU emailed.

 
Bishop Physical Therapy
Department of Physical Therapy
Daniel Bishop
Phone: 251-626-7778
1203 US 98 #1
Daphne AL 36526
Agency Email: bishop.pt@aol.com
Expiration Date: 2022-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-08-22
Sent to Legal:
Completed: 2019-08-29
Requester Name: Carla Huggins
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Body Pros Physical Therapy
Department of Physical Therapy
Robert Canecchio, Jr
Phone: 678-624-9117
1750 Founders Parkway Ste 130
Alpharetta GA 30009
Agency Email: robcanecchio@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Pain Care
School of Nursing
Melissa Campbell
Phone: 770-771-6580
1365 Rock Quarry Road Suite 202
Stockbridge GA 30281
Agency Email:
Expiration Date: 2014-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Dortch Dortch
Document 1: view
Document 2:
Document 3:

 
Pain Consultants of Atlanta
School of Nursing
Ashley Bernal
Phone: 404-351-7654
1800 Peachtree Street Suite 400
Atlanta GA 30309
Agency Email:
Expiration Date: 2013-01-10
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Beshara
Document 1: view
Document 2:
Document 3:

 
Park Springs
Department of Nutrition
Margot Witteveen
Phone: 678-684-3095
600 Springhouse Circle
Stone Mountain GA 30087
Agency Email: margorwitteveen@parksprings.com
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-29
Sent to Provost: 2014-06-10
Sent to Legal:
Completed: 2014-06-19
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Peachford Behavioral Health System of Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Dixi Belen
Phone: 770-454-2355
2151 Peachford Road
Atlanta GA 30338
Agency Email: Dixi.Belen@uhsinc.com
Expiration Date: 2024-03-08
Sent to Facility:
Sent to Provost: 2018-01-22
Sent to Legal:
Completed: 2021-04-16
Requester Name: Lisa Williams
Document 1: Peachford Hospital_03-08-2024
Document 2:
Document 3:

 
CarePlus Family Medicine - Riverdale
Byrdine F Lewis School of Nursing and Health Professions
Alia Carter
Phone: 770-907-7222
83 Upper Riverdale Road Suite 135
Riverdale GA 30274
Agency Email: aliacarter.apc@gmail.com
Expiration Date: 2024-02-29
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-16
Requester Name: Lisa Williams
Document 1: CarePlus Family Medicine - Riverdale_exp02-29-2024
Document 2:
Document 3:

 
Peachtree City Physicians Group, PC
School of Nursing
Kathleen C Leoffler
Phone: 770-632-8909
1401 Georgian Park Drive
Peachtree City GA 30269
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-19
Sent to Provost: 2013-12-02
Sent to Legal:
Completed: 2013-12-06
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Pediatric Clinic
School of Nursing
Jane Wu
Phone: 770-458-3383
3020 Mercer University Drive Suite 100
Atlanta GA 30341
Agency Email:
Expiration Date: 2013-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sybert
Document 1: view
Document 2:
Document 3:

 
Pediatric GI Center - Central GA
School of Nursing
Noel Israel
Phone: 478-633-7330
722 1st Street
Macon GA 31201
Agency Email:
Expiration Date: 2014-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1: view
Document 2:
Document 3:

 
Peds Care, PC
School of Nursing
Joyce Hooker
Phone: 706-278-6628
711 Shields Road
Dalton GA 30720
Agency Email:
Expiration Date: 2013-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sybert
Document 1: view
Document 2:
Document 3:

 
Performance Physical Therapy, PC
Department of Physical Therapy
Barney Poole
Phone: 770-506-6993
917 Eagles Landing Parkway
Stockbridge GA 30281
Agency Email: bpoolept@hotmail.com
Expiration Date: 2019-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Perimeter Medical Associates, PC
School of Nursing
Steven Patton
Phone: 404-446-1340
3775 North Druid Hills Road
Decatur GA 30033
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:

 
Perimeter North Family Medicine
School of Nursing
Natalie Carrithers
Phone: 404-255-7325
960 Johnson Ferry Road Suite 300
Atlanta GA 30342
Agency Email:
Expiration Date: 2013-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Physicians Care Clinic
School of Nursing
Carole Fortenberry
Phone: 404-501-7960
2675 N Decatur Road Suite 610
Decatur GA 30033
Agency Email:
Expiration Date: 2014-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Joan Bacon
Document 1: view
Document 2:
Document 3:

 
Physicians for Women, PC
School of Nursing
Susan Robertson
Phone: 478-922-9944
1021 North Houston Road
Warner Robbins GA 31093
Agency Email: srobertson@pfwobgyn.com
Expiration Date: 2020-01-31
Sent to Facility: 2020-03-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Physiotherapy Associates
Department of Physical Therapy
Melanie Walls
Phone: 484-798-1035
1905 SE 16th Street
Cape Coral FL 33990
Agency Email: Melanie.Walls@physiocorp.com
Expiration Date: 2017-03-31
Sent to Facility: 2014-01-17
Sent to Provost: 2014-04-10
Sent to Legal:
Completed: 2014-05-14
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Rehab Associates

 
Piedmont Healthcare, Inc.
Byrdine F Lewis College of Nursing and Health Professions
Marci Starkman
Phone: 404-425-7370
1800 Howell Mill Road Suite 350
Atlanta GA 30318
Agency Email: kay.oates@piedmont.org
Expiration Date: 2024-12-12
Sent to Facility: 2018-11-07
Sent to Provost: 2018-10-02
Sent to Legal:
Completed: 2021-09-20
Requester Name: Kelli Nowviskie
Document 1: view
Document 2: view
Document 3:
Comment: Covers entire college 10/2/18 Working with Esha McTizic who is facilitating this contract that will cover Lewis College students.

 
Redmond Park Hospital, LLC d/b/a Redmond Regional Medical Center
Byrdine F. Lewis College of Nursing and Health Professions
Missy Ragland
Phone: 706-802-3160
501 Redmond Road PO Box 107001
Rome GA 30164-7001
Agency Email: Melissa.Ragland@hcahealthcare.com
Expiration Date: 2022-10-21
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Redmond Final January 2019
Document 2:
Document 3:
Comment: Covered under Tristar Health System, Inc.

 
Rehab Associates
Department of Physical Therapy
Roxanne St Martin
Phone: 334-272-8255
207 Interstate Park Drive
Montgomery AL 36106
Agency Email:
Expiration Date: 2017-03-31
Sent to Facility: 2014-01-17
Sent to Provost: 2014-04-10
Sent to Legal:
Completed: 2014-05-14
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Covered by Physiotherapy Corporation

 
Rehab South
Department of Physical Therapy
George Girolami
Phone: (770) 991-2747
150 Medical Way Suite E-1
Riverdale GA 30274
Agency Email:
Expiration Date: 2016-10-31
Sent to Facility: 2013-08-20
Sent to Provost: 2013-08-26
Sent to Legal:
Completed: 2013-09-11
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: see BenchMark

 
Renown Health
Department of Physical Therapy
Jenna Martineau
Phone: 775-982-3576
1316 Capital Boulevard Suite 101
Reno NV 89502
Agency Email: StudentTherapyProgram@renown.org
Expiration Date: 2017-10-14
Sent to Facility: 2017-04-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed. follow up email sent by carla 10/25/17 new mou recieved and sent to caroline lombard 11/10 changes from caroline lombard sent on 12/13 8/29/18 Renown decided not to move forward with their agreement with GSU

 
Restore Health Group
Department of Physical Therapy
James Kelly
Phone: 770-563-8248
200 Galleria Parkway Suite 1800
Atlanta GA 30339
Agency Email: jim.kelly@restorehealthgroup.com
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-03-29
Requester Name: Carla Huggins
Document 1: Restore Health Group
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
Ridgeview Institute - Smyrna
Byrdine F Lewis College of Nursing and Health Professions
Faith Connell
Phone: 770-434-4567, x2013
3995 South Cobb Drive
Smyrna GA 30080-6397
Agency Email: fconnell@ridgeviewinstitute.com
Expiration Date: 2025-04-30
Sent to Facility: 2019-03-05
Sent to Provost: 2019-03-06
Sent to Legal:
Completed: 2019-03-09
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:

 
Caroline L. Young MS, RD, LD RYT DBA: Whole Self Nutrition
Department of Nutrition
Caroline Young
Phone: 7706397725
4441 Northside Parkway NW #271
atlanta Ga 30327
Agency Email: thewholeyogird@gmail.com
Expiration Date: 2022-06-30
Sent to Facility: 2019-07-11
Sent to Provost: 2019-07-31
Sent to Legal:
Completed: 2019-08-29
Requester Name: jessica todd
Document 1: Final Expires June 2022
Document 2:
Document 3:

 
River Edge Behavioral Health Center
School of Nursing
Miranda Nunez
Phone: 478-803-7795
175 Emery Highway
Macon GA 31217
Agency Email: mnunez@river-edge.org
Expiration Date: 2017-11-30
Sent to Facility: 2014-11-19
Sent to Provost: 2014-11-21
Sent to Legal:
Completed: 2014-12-08
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:

 
Riverwoods Behavioral Health System/Acadia Healthcare Inc.
School of Nursing
Marie Walters
Phone: 760-553-3884
223 Medical Center Drive
Riverdale GA 30274
Agency Email: marie.walters@riverwoodsbehavioralhealth.com
Expiration Date: 2022-07-31
Sent to Facility: 2019-08-05
Sent to Provost: 2019-08-07
Sent to Legal:
Completed: 2019-08-08
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:

 
Rockdale Medical Center, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Ruth Roebuck
Phone: 770-918-3876
1412 Milstead Avenue NE
Conyers GA 30012
Agency Email:
Expiration Date: 2017-05-31
Sent to Facility: 2017-02-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Vedica Eastman
Document 1: view
Document 2:
Document 3:
Comment: According to Ruth Roebuck, Clinical Nurse Educator, Rockdale decided not to renew the contract with GSU. No explanation was given.

 
Dr. Ron Smith, MD Pediatric and Adolescent Medicine, PC
School of Nursing
Ron Smith
Phone: 678-583-9071
543 Jonesboro Road
McDonough GA 30253
Agency Email: linda@ronsmithmd.com
Expiration Date: 2017-03-31
Sent to Facility: 2014-03-26
Sent to Provost: 2014-03-27
Sent to Legal:
Completed: 2014-04-10
Requester Name: Regena Spratling
Document 1:
Document 2:
Document 3:

 
Roosevelt Warm Springs Rehabilitation & Specialty Hospitals, Inc.
Department of Physical Therapy
Jane Jaudon
Phone: 706-655-5308
6135 Roosevelt Highway/94 Pine Road
Warm Springs GA 31830
Agency Email:
Expiration Date: 2025-12-31
Sent to Facility: 2018-11-21
Sent to Provost: 2018-11-30
Sent to Legal:
Completed: 2022-02-01
Requester Name: Carla Huggins
Document 1: 2019 Final PT and OT
Document 2:
Document 3:
Comment: PT & OT Copy ptclinicaleducation@gsu.edu

 
Doctors Hospital of Augusta
Department of Physical Therapy
Retha Anderson
Phone: (706) 651-6688
3651 Wheeler Road
Augusta GA 30909
Agency Email: Retha.Anderson@hcahealthcare.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Rophe Adult and Pediatric Medicine
School of Nursing
Sondra Maragh
Phone: 770-964-7736
4910 Jonesboro Road Building 700
Union City GA 30291
Agency Email: smaragh@rophemed.com
Expiration Date: 2018-11-30
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please renew; original request 9/2018. lyw

 
Roswell OB/GYN,LLC
School of Nursing
Kelly Rossiter
Phone: 770-751-3600
684 Sixes Road Suite 235
Holly Springs GA 30115
Agency Email: krossiter@awhg.org
Expiration Date: 2023-08-31
Sent to Facility: 2020-07-10
Sent to Provost: 2020-09-02
Sent to Legal:
Completed: 2020-09-11
Requester Name: Lisa Williams
Document 1: Roswell OBGYN
Document 2:
Document 3:

 
Saco Bay Orthopaedic & Sports Physical Therapy, PA
Department of Physical Therapy
Gabriel Redmond
Phone: 207-282-7121
29 Foden Road
South Portland ME 04106
Agency Email:
Expiration Date: 2014-11-30
Sent to Facility: 2011-09-08
Sent to Provost: 2011-10-13
Sent to Legal:
Completed: 2011-10-31
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Part of Select Medical/Select PT. Does not need a separate agreement.

 
Safehouse Outreach
BFLCNHP
Phillip Bray
Phone: 404-523-2221
P. O. Box 54098
Atlanta GA 30308
Agency Email: philip@safehouseoutreach.org
Expiration Date: 2020-10-31
Sent to Facility: 2017-10-17
Sent to Provost: 2017-10-24
Sent to Legal:
Completed: 2017-10-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:

 
Saint Francis Hospital, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Tammy Shelly
Phone: 706-595-4152
2122 Manchester Expressway
Columbus GA 31904
Agency Email: ShelleyT@sfhga.com
Expiration Date: 2019-01-03
Sent to Facility: 2018-11-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: renewal sent 11/27/18

 
Saint Josephs Hospital of Atlanta, Inc. and Saint Josephs Mercy Care Services, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Allison Hager
Phone: 678-843-7977
Organizational Development & Education 5665 Peachtree Dunwoody Road, NE
Atlanta GA 30342
Agency Email: Allison.Hager@emoryhealthcare.org
Expiration Date: 2025-04-30
Sent to Facility: 2012-12-14
Sent to Provost: 2013-01-07
Sent to Legal:
Completed: 2022-06-09
Requester Name: Chip Zimmerman
Document 1:
Document 2:
Document 3:
Comment: brandied.mcclain@mercyatlanta.com (Brandied McClain handled contract processing 6-09-2022 ncl St Joseph Primary Care Network & Mercy Mobile Health Care; Sent e- mail to Allison Hager to renew 6/3/14

 
Saint Josephs/Candler Health System, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Lisa Alvarez
Phone: 912-819-8364
5353 Reynolds Street
Savannah GA 31405
Agency Email: alvarezl@sjchs.org
Expiration Date: 2024-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-08-20
Requester Name: Carla Huggins
Document 1: Saint Josephs/Candler Health System, Inc.
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu on communication

 
Select Physical Therapy Holdings, Inc.
Department of Physical Therapy
Julia Dodd
Phone: 770-889-8758
Select Medical Corporation, Corporate Legal Department 4714 Gettysburg Road
Mechanicsburg PA 17055
Agency Email: judodd@selectmedical.com
Expiration Date:
Sent to Facility: 2017-02-17
Sent to Provost: 2017-06-05
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: New MOU requested as this one has been renewed twice.MOU emailed. Received MOU template and sent to Legal for review 4/17. Sent to Legal for Provost signature 5/25.Sent to Facility for signature 6/12/17.

 
The Johns Hopkins Hospital
Department of Respiratory Therapy
Melanie Torain
Phone: 410 735 6505
600 N Wolfe Street Administration 400
Baltimore MD 21287-1900
Agency Email: mtorain1@jhmi.edu
Expiration Date: 2021-05-31
Sent to Facility: 2016-04-12
Sent to Provost: 2016-07-18
Sent to Legal:
Completed: 2016-07-27
Requester Name: Chip Zimmerman
Document 1:
Document 2:
Document 3:
Comment: This is a FIVE year agreement.

 
Senior Connections
Department of Nutrition
Christine Mikstas
Phone: 770-455-7602 x107
5238 Peachtree Road
Chamblee GA 30341-2718
Agency Email: cmikstas@seniorconnectionsatl.org
Expiration Date: 2020-01-31
Sent to Facility: 2016-11-09
Sent to Provost: 2016-11-11
Sent to Legal:
Completed: 2017-11-17
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Shepherd Center, Inc.
Department of Occupational Therapy
John McDaniel
Phone: 404-350-7340
2020 Peachtree Road, NW
Atlanta GA 30309
Agency Email: glenn_prescott@shepherd.org
Expiration Date: 12/31/2023
Sent to Facility: 2019-09-27
Sent to Provost: 2019-07-08
Sent to Legal: 2019-06-12
Completed: 2019-11-04
Requester Name: Jennifer Nelson
Document 1: view
Document 2: Exp Dec 2023 shepherd center exp 2023
Document 3:

 
Shifa Al Asqam Medical Center
School of Nursing
Nevorn Askari
Phone: 404-687-3351
1836 Second Avenue
Decatur GA 30032
Agency Email: shifamedical@hotmail.com
Expiration Date: 2019-05-31
Sent to Facility: 2016-04-06
Sent to Provost: 2016-05-23
Sent to Legal:
Completed: 2016-05-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Per Clincial Coordinator, Lisa Williams, site is not appropriate for student clinicals at this time.

 
Sibley Heart Center Cardiology-Egleston Childrens Heart Center, Inc.
Byrdine F. Lewis School of Nursing & Health Professions
Martha Guerra
Phone: 770-488-9222
2835 Brandywine Drive Suite 300
Atlanta GA 30341
Agency Email: guerram@kidsheart.com
Expiration Date: 2022-11-12
Sent to Facility: 2018-09-19
Sent to Provost: 2018-10-02
Sent to Legal:
Completed: 2021-11-30
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 9/19/18 renewal initiated, covers multiple departments 9/28/18 Facility sent their MOU 10/2/18 Sent to legal and provost 11/19/18 sent signed by provost via email, inquired as to need for wet signatures. Still need facility signature 11/20 received signature. complete.

 
South Coast Health
School of Nursing
Lisa Mew
Phone: 912-527-5352
10055 Ford Avenue Suite 4A
Richmond Hill GA 31324
Agency Email: lmew@southcoastmedical.com
Expiration Date: 2020-05-31
Sent to Facility: 2017-06-09
Sent to Provost: 2017-06-12
Sent to Legal:
Completed: 2017-06-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Atlanta VA Medical Center

Wilma West
Phone: 404-321-6111 ext 7445
1670 Clairmont Rd
Decatur GA 30033
Agency Email: wilma.west@va.gov
Expiration Date:
Sent to Facility: 2016-08-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Sent email request to Ms. West 8/10.Sent to Legal for Provost signature 10/21.

 
Siskin Hospital for Physical Rehabilitation
Department of Physical Therapy
Aileen San Luis
Phone: 423-634-1389
One Siskin Plaza
Chattanooga TN 37403
Agency Email: asanluis@siskinrehab.org
Expiration Date: 2017-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please copy Masiki Williamson on communication at ptclinicaleducation@gsu.edu. Thank you.

 
Snellville Pediatrics, PC
School of Nursing
Madeline Rutledge
Phone: 678-775-1501
1700 Tree Lane Road Suite 110
Snellville GA 30078
Agency Email: mrutledge@snellvillepeds.com
Expiration Date: 2023-03-31
Sent to Facility: 2020-03-27
Sent to Provost: 2020-05-13
Sent to Legal:
Completed: 2020-06-23
Requester Name: Lisa Williams
Document 1: ExpMar2023 SnellvillePeds_Final pdf
Document 2:
Document 3:

 
South DeKalb Center for Healthy Living
School of Nursing
Renee Ransom
Phone: 404-484-2777
2699 Klondike Road
Lithonia GA 30058
Agency Email:
Expiration Date: 2013-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Cox
Document 1: view
Document 2:
Document 3:

 
Southeastern Fitness and Rehabilitation
Department of Physical Therapy
Darren Cady
Phone: 828-274-2188
23 Turgle Creek Drive
Asheville NC 28803
Agency Email:
Expiration Date: 2015-09-30
Sent to Facility: 2012-08-20
Sent to Provost: 2012-09-20
Sent to Legal:
Completed: 2012-10-03
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Southeastern Lung Care
BFLCNHP
A Lynn Discordia
Phone: 404-294-4018
2665 North Decatur Road Suite 430
Decatur GA 30033
Agency Email: lynn@southeasternlungcare.com
Expiration Date: 2023-02-28
Sent to Facility: 2020-02-24
Sent to Provost: 2020-03-09
Sent to Legal:
Completed: 2020-03-16
Requester Name: Lisa Williams
Document 1: exp feb 2023 ...6133549 pdf
Document 2:
Document 3:
Comment: 2/18/20 - please renew. LYW

 
The Sport Factory
Department of Nutrition
Matt Russ
Phone: 770-842-7317
185 Shelli Lane
Roswell GA 30075
Agency Email:
Expiration Date: 2013-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
The Sports Rehabilitation Center
Department of Physical Therapy
Brian Tovin
Phone: 404-477-8888
555 10th Street
Atlanta GA 30318
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-08-14
Sent to Provost: 2013-09-11
Sent to Legal:
Completed: 2013-09-27
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
The University of Chicago Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Marla Robinson
Phone: 773-795-7192
5841 South Maryland Avenue MC1081, Therapy Services
Chicago IL 60637
Agency Email: Marla.Robinson@uchospitals.edu
Expiration Date: 2017-02-23
Sent to Facility: 2016-12-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
The University of Georgia University Health Center
School of Nursing
Julia Nelms
Phone: (706) 542-8715
University Health Center University of Georgia
Athens GA 30602-1755
Agency Email: jnelms@uhs.uga.edu
Expiration Date: 2018-03-30
Sent to Facility: 2014-11-26
Sent to Provost: 2015-01-08
Sent to Legal:
Completed: 2015-02-18
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
The Womens Center, PC
School of Nursing
Steppanie Gordon
Phone: 678-413-4644
2750 Owens Drive Suite A
Conyers GA 30094-3929
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-02-23
Sent to Provost: 2013-09-17
Sent to Legal:
Completed: 2013-09-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Womens Group of Gwinnett
BFLCNHP
Janet Mungenast
Phone: 770-979-4700
500 Medical Center Boulevard Suite 250
Lawrenceville GA 30046
Agency Email: jmungenast@awhg.org
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-16
Sent to Provost: 2020-01-23
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: view
Document 2: exp dec 2022 ...4122553.pdf
Document 3:
Comment: pdf final ok

 
Therapy Management Corporation, Inc.
Department of Physical Therapy
Heather Torres
Phone: 352-601-7096
8477 S. Suncoast Boulevard
Homosassa FL 34446
Agency Email: htorres@therapymgmt.com
Expiration Date: 2023-05-31
Sent to Facility: 2019-11-14
Sent to Provost:
Sent to Legal:
Completed: 2019-12-12
Requester Name: Carla Huggins
Document 1: Exp May 2020 therapy mgmt
Document 2: Final Exp May 2023 ...125114pdf
Document 3:
Comment: TriStar Rehab, TLC Rehab, Quality Care Rehab, and Rehab Advantage, Inc, 12/20/19 uploaded final into 2nd doc ...125114pdf

 
Toccoa Clinical Medical Associates dba NGPG Toccoa Clinic
School of Nursing
Deborah Gibby
Phone: 706-886-7537
58 Big A Road
Toccoa GA 30577
Agency Email: DGibby@toccoaclinic.com
Expiration Date: 2020-05-31
Sent to Facility: 2020-04-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2: Email RE NGPG Toccoa Clinic
Document 3:
Comment: Please renew. LYW 7/29/19 Toccoa Clinical Medical Associates now known as NGPG Toccoa Clinic is covered under Northeast Georgia Physicians Group. 4/29/2020 renewal request sent to Northeast Georgia Physicians Group which includes this facility.

 
Faith Healthcare Services, Inc.
BFLCNHP
Angella Samuels
Phone: 770-248-1637
2795 Main Street SW Building 21
Snellville GA 30078-3164
Agency Email: info@faithhealthcareservices.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-02-05
Sent to Provost: 2018-02-05
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: C. Lombardi will send out contract listing nursing home facilities. 2/5/18 - sent to site. LYW

 
Total Wellness Concepts, Inc.
School of Nursing
Joan Mitchell
Phone: 478-284-1116
60 Highway 22 West
Milledgeville GA 31061
Agency Email:
Expiration Date:
Sent to Facility: 2014-02-07
Sent to Provost: 2014-02-11
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Sent to OLA for sigs 2/19/14

 
Turning Point Women's Healthcare
Department of Physical Therapy
Jill Binkley
Phone: 770-360-9271
11180 State Bridge Road Suite 503
Alpharetta GA 30022
Agency Email:
Expiration Date: 2013-10-13
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2011-03-01
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
Twin Lakes Physical Therapy, Inc.
Department of Physical Therapy
Constance Wesson
Phone: 478-452-6252
641 W. Thomas Street
Milledgeville GA 31061
Agency Email: cwesson@twinlakespt.com
Expiration Date: 2014-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy Masiki Williamson (ptclinicaleducation@gsu.edu)on communication

 
Collaborative Care Services (Optum)
School of Nursing
Rhonda Ligon
Phone: 678-234-7449 Cell
3720 DaVinci Court Suite 400
Norcross GA 30092
Agency Email: rhonda.l.ligon@optum.com
Expiration Date: no expiration date
Sent to Facility: 2015-09-08
Sent to Provost: 2015-10-08
Sent to Legal:
Completed: 2015-12-04
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
Comment: Revisions approved and sent to Legal for Provost signature 10/7/15. auto renews Agreement is shall continue until either party terminates with cause in writing.

 
United States Public Health Services
Department of Nutrition
Vangie Ramos-Tate
Phone: 926-338-3574
PO Box 860 200 West Hospital Drive
Whiteriver AZ 85941
Agency Email:
Expiration Date: 2013-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
University Health Systems, Inc.
Department of Physical Therapy
Susan Reynold
Phone: 865-305-6925
1520 Cherokee Trail Suite 330
Knoxville TN 37920
Agency Email: sreynold@mc.utmck.edu
Expiration Date: 2021-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
The Board of Trustees of the University of Alabama for the University of Alabama Hospital-PT
Department of Physical Therapy
Denise Graham
Phone: 205-934-8242
UAB-Spain Rehabilitation Center 1717 6th Avenue South, SRC R044P
Birmingham AL 35249
Agency Email: dgraham@uabmc.edu
Expiration Date: 2022-11-30
Sent to Facility: 2019-07-01
Sent to Provost:
Sent to Legal: 2019-06-10
Completed: 2019-07-03
Requester Name: Carla Huggins
Document 1: Final Expires November 2022
Document 2:
Document 3:
Comment: 5/28/19 Renewal Initiated, inclusive of all programs 7/1/19 Provost signed, to facility for final signature

 
Upson Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Sue Adams
Phone: (706) 647-8111 x1337
PO Drawer 1059
Thomaston GA 30286-0013
Agency Email:
Expiration Date:
Sent to Facility: 2012-08-20
Sent to Provost: 2012-08-21
Sent to Legal:
Completed: 2012-08-28
Requester Name: Jennifer Cline
Document 1: view
Document 2:
Document 3:
Comment: The site cancelled the MOU by letter as of July 1, 2014

 
Valdosta Psychiatric Associates, LLC
School of Nursing
Jenny Kenyon
Phone: 229-244-4200
PO Box 3229
Valdosta GA 31604
Agency Email:
Expiration Date: 2014-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Valdosta State University Student Health Services
School of Nursing
Lynette Lewis
Phone: 229-333-5886
VSU Student Health Center 200 Georgia Avenue
Valdosta GA 31698
Agency Email:
Expiration Date:
Sent to Facility: 2012-07-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carol Howell
Document 1:
Document 2:
Document 3:
Comment: Facility Does Not Participate in Clinicals

 
Venture Physical Therapy-Marietta
Department of Physical Therapy
Paul Mattson
Phone: 770- 424-6787
631 Campbell Hill Street Suite 200
Marietta GA 30060
Agency Email: mattson1068@att.net
Expiration Date: 2018-12-31
Sent to Facility: 2018-10-19
Sent to Provost: 2018-10-24
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires December 2021
Document 2:
Document 3:
Comment: scanned copy of final agreement OK

 
Encompass Health Rehabilitation Hospital of Newnan
Department of Occupational Therapy
Leigh Whitton
Phone: 678-552-6232
2101 E. Newnan Crossing Blvd.
Newnan GA 30265
Agency Email: leigh.whitton@encompasshealth.com
Expiration Date: 2020-08-31
Sent to Facility:
Sent to Provost: 2020-02-14
Sent to Legal:
Completed: 2020-07-01
Requester Name: Elias Brown
Document 1: ExpJuly2021 EncompassNewnanFinal
Document 2:
Document 3:

 
Volunteer Behavioral Health Care System
School of Nursing
Candy Templeton
Phone: 615-278-6360
PO Box 1559
Murfreesboro TN 37133-1559
Agency Email:
Expiration Date: 2014-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Walton Rehabilitation Health Systems
Byrdine F Lewis School of Nursing and Health Professions
Cheryl Howard
Phone: 706-724-7746
1355 Independence Drive Outpatient Building
Augusta GA 30901-1037
Agency Email:
Expiration Date: 2017-05-12
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: COVERED UNDER HEALTHSOUTH CORPORATION.

 
Hospital Authority of Wayne County (The)
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Deal
Phone: 912-530-3183
865 South First Street PO Box 410
Jesup GA 31545
Agency Email: jdeal@wmhweb.com
Expiration Date: 2020-06-30
Sent to Facility: 2020-02-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Well Body Clinic, Inc.
Department of Physical Therapy
Sarah Labrecque
Phone: 941-747-7741
3915 8th Avenue West
West Bradenton FL 34205
Agency Email:
Expiration Date: 2012-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name:
Document 1:
Document 2:
Document 3:

 
Wellness Medicine
School of Nursing
Sandra Moore
Phone: 678-479-1234
990 Bear Creek Boulevard Suite G
Hampton GA 30228
Agency Email: sandramoore346@gmail.com
Expiration Date: 2020-06-30
Sent to Facility: 2017-03-17
Sent to Provost: 2017-05-05
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed. Sent to Legal for Provost signature 5/5.

 
WellStar Health System, Inc.
Department of Occupational Therapy
Camille Flanagan
Phone: 470-956-6448
Organzational Learning 2000 South Park Place
Atlanta GA 30339
Agency Email: camille.flanagan@wellstar.org
Expiration Date: 2022-06-01
Sent to Facility: 2019-05-30
Sent to Provost: 2019-04-17
Sent to Legal: 2019-02-18
Completed: 2020-05-12
Requester Name: Jennifer Nelson
Document 1: WellstarHealthSystems_Final ExpJune2022
Document 2: WellstarAddendumsALL Programs
Document 3: Wellstar-addendum-2017.pdf

 
Dr. Wendy Vendemark, MD
School of Nursing
Wendy Vandemark
Phone: 229-244-9688
2310 N Patterson Street Suite G
Valdosta GA 31602
Agency Email:
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:

 
West Georgia Medical Center d/b/a West Georgia Health
Department of Physical Therapy
Joyce Ellis-Johnson
Phone: 706-845-3201
1514 Vernon Road Physical Therapy Department
LaGrange GA 30240
Agency Email:
Expiration Date:
Sent to Facility: 2014-11-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Received Affiliation Agreement Termination Letter Dated November 1, 2016.

 
Archbold Memorial Hospital, Inc.
Department of Occupational Therapy
Donna McMillan
Phone: 229-228-2795
915 Gordon Avenue
Thomasville GA 31792
Agency Email: dmcmillan@archbold.org
Expiration Date: 2020-06-30
Sent to Facility: 2017-07-19
Sent to Provost: 2017-10-24
Sent to Legal:
Completed: 2017-10-27
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: complete

 
Dr. William E. Freeman, MD
School of Nursing
William E Freeman
Phone: 478-953-1020
136 South Houston Lake Road
Warner Robbins GA 31088-6300
Agency Email: brenda@williamfreemanmd.com
Expiration Date: 2018-11-30
Sent to Facility: 2015-09-01
Sent to Provost: 2015-09-09
Sent to Legal:
Completed: 2015-09-18
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:

 
Clinica Medcare
School of Nursing
Mallory Sahni
Phone: 760-412-7047
2505 Chamblee Tucker Road Suite 110
Chamblee GA 30341
Agency Email: clinicamedcare.chamblee@gmail.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-14
Sent to Provost: 2017-11-16
Sent to Legal:
Completed: 2017-12-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/29/2021 - This facility is closed. LYW

 
Women's Medical Center
School of Nursing
Shannon Scott
Phone: 770-997-5714
190 Handley Road #A
Tyrone GA 30290
Agency Email:
Expiration Date: 2014-09-30
Sent to Facility: 2011-09-19
Sent to Provost: 2011-10-06
Sent to Legal:
Completed: 2011-10-17
Requester Name: Sandy Hewell
Document 1:
Document 2:
Document 3:

 
Woodstock Pediatric Medicine
BFLCNHP
Kelly Marulanda
Phone: 770-517-0250
2000 Professional Way Suite 200
Woodstock GA 30188
Agency Email: kellym@woodstockpeds.com
Expiration Date: 2022-04-30
Sent to Facility: 2019-04-12
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2019-05-29
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: Please issue a new contract. 9/3/19 received from legal, signed by provost on 5/29/19

 
Yamato Orthopedic and Spinal Rehabilitation
Department of Physical Therapy
Bradley Goldman
Phone: 561-477-6929
9101 Lakeridge Boulevard Suite 23
Boca Raton FL 33496
Agency Email: yosr@aol.com
Expiration Date:
Sent to Facility: 2018-07-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 7/18/18 MOU Emailed

 
Family Systems Therapy
School of Nursing
Jean Blackburn
Phone: 423-698-8414
P. O. Box 3582
Chattanooga TN 37404
Agency Email:
Expiration Date: 2017-06-30
Sent to Facility: 2014-06-03
Sent to Provost: 2014-06-16
Sent to Legal:
Completed: 2014-06-26
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Franklin Primary Care Clinic
School of Nursing
Ann Hastings
Phone: 706-675-8669
1236 Franklin Parkway
Franklin GA 30217
Agency Email:
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-31
Sent to Provost: 2014-02-07
Sent to Legal:
Completed: 2014-02-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Advanta Total Health, LLC
School of Nursing
Janie Hensley
Phone: 770-955-2225
1720 Powers Ferry Road Suite 100
Marietta GA 30067
Agency Email:
Expiration Date: 2014-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:

 
CVS Caremark/Minute Clinic, LLC
School of Nursing
Amy Waggoner
Phone: 401-770-3425
One CVS Drive 100SVD
Woonsocket RI 02895
Agency Email: kelly.barnes@cvs.com
Expiration Date: Auto Renews
Sent to Facility: 2018-08-14
Sent to Provost: 2018-07-11
Sent to Legal:
Completed: 2018-08-20
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: 7/11/18 Redlined agreement from C. Lombard sent to facility for review/signature 8/14/18 Provost signed, emailed to facility to sign. 8/20/18 Complete. Uploaded agreement, COI and FAQ from facility.

 
Apogee Women's Health
School of Nursing
Anthony Adams
Phone: 404-767-8886
2575 Jolly Road Atlanta GA 30349
Agency Email:
Expiration Date: 2014-05-31
Sent to Facility: 2011-08-26
Sent to Provost: 2011-09-02
Sent to Legal:
Completed: 2011-09-22
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:
Comment: Do Not Renew-Will Only Precept For Pay.

 
Bremen Family Health & Wellness Center
School of Nursing
Becky Mattingly
Phone: 770-537-5555
509 Alabama Avenue
Breman GA 30110
Agency Email: beckymattingly@bellsouth.net
Expiration Date: 2017-06-30
Sent to Facility: 2017-03-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
Childrens Therapy Works
Department of Physical Therapy
Amy Campbell
Phone: 770-754-0085
11660 Alpharetta Hwy Suite 320
Roswell GA 30076
Agency Email: Shelley Margow
Expiration Date: 2019-07-31
Sent to Facility: 2019-03-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please renew

 
Dr. W. Steven Wilson, MD, PC
School of Nursing
Anna Alexander
Phone: 478-322-0032
129 Carl Vinson Parkway
Warner Robbins GA 31088
Agency Email: anna.alexander@cox.net
Expiration Date: 2018-03-31
Sent to Facility: 2015-03-24
Sent to Provost: 2015-03-24
Sent to Legal:
Completed: 2015-04-03
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Partnership for Community Action, Inc.
School of Nursing
Vanessa Brown
Phone: 404-929-2445
815 Park North Blvd Clarkston GA 30021
Agency Email:
Expiration Date:
Sent to Facility: 2012-08-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1:
Document 2:
Document 3:

 
Tender Ones Therapy Services, Inc. - OT
Department of Occupational Therapy
Noreen Zulaica
Phone: 770-904-6009
2089 Teron Trace Suite 120
Dacula Ga 30019
Agency Email: therapy@tenderones.com
Expiration Date: 2022-11-30
Sent to Facility: 2019-11-22
Sent to Provost: 2019-12-04
Sent to Legal:
Completed: 2019-12-09
Requester Name: Shana Finks
Document 1: Expires August 2019
Document 2: Final Expires Nov 2022 ...93650pdf
Document 3:

 
National Peanut Board
Department of Nutrition
Sherry Collins
Phone: 678-424-5717
2839 Paces Ferry Road Suite 210
Atlanta GA 30339
Agency Email:
Expiration Date: 2014-12-31
Sent to Facility: 2011-10-27
Sent to Provost: 2011-11-22
Sent to Legal:
Completed: 2011-12-16
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Center for Primary Care
School of Nursing
Rhonda Herndon
Phone: 706-868-7380
3614-D J. Dewey Gray Circle
Augusta GA 30909
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-01-31
Sent to Provost: 2013-02-19
Sent to Legal:
Completed: 2013-02-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Northwoods United Methodist Church
School of Nursing
Winston Worrell
Phone: 770-457-4576
2635 Fairlane Drive Doraville GA 30340
Agency Email:
Expiration Date: 2014-11-30
Sent to Facility: 2011-11-10
Sent to Provost: 2011-11-28
Sent to Legal:
Completed: 2011-12-07
Requester Name: Kenya Kirkendoll
Document 1:
Document 2:
Document 3:

 
Dourron OB/GYN Associates, PC
School of Nursing
Julie Dourron
Phone: 770-883-0114
2675 North Decatur Road Suite 301
Decatur GA 30033
Agency Email:
Expiration Date: 2014-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:
Comment: Can only handle one student this year.

 
Cumberland Pediatrics, P.C.
School of Nursing
Regina Mixon
Phone: 770-951-5400
1405 Franklin Road
Marietta GA 30067
Agency Email: cpmanager@cumberlandpediatrics.com
Expiration Date: 2023-06-30
Sent to Facility: 2020-04-30
Sent to Provost: 2020-05-11
Sent to Legal:
Completed: 2020-06-15
Requester Name: Lisa Williams
Document 1: ExpJune2023 CumberlandPeds for Provost pdf
Document 2:
Document 3:

 
Center of Hope at Thomasville Heights
School of Nursing
Jamaal Greer
Phone: 404-624-0816
1825 Henry Thomas Drive, SE
Atlanta GA 30315
Agency Email:
Expiration Date: 2014-12-31
Sent to Facility: 2011-11-29
Sent to Provost: 2011-12-08
Sent to Legal:
Completed: 2011-12-16
Requester Name: Kenya Kirkendoll
Document 1: view
Document 2:
Document 3:

 
Wellstar Medical Group Family Medicine Bridgemill
School of Nursing
Marie Mulkey
Phone: 770-720-1880
3755 Sixes Road Suite 202
Canton GA 30114
Agency Email: mhmulkey@aol.com
Expiration Date: 2017-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covered under Wellstar MOU.

 
Good Samaritan Health and Wellness
School of Nursing
Jean Mosshart
Phone: 706-253-4673
175 Samaritan Drive Attn: Volunteer Office
Jasper GA 30143
Agency Email: volunteer@goodsamhwc.org
Expiration Date: 2017-12-31
Sent to Facility: 2014-11-26
Sent to Provost: 2014-12-02
Sent to Legal:
Completed: 2014-12-08
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Clayton County Public School-OT
Department of Occupational Therapy
Alisha Albritten
Phone: 770 473-2700 ext 700173
1058 Fifth Ave Human Resources
Jonesboro GA 30236
Agency Email: alisha.albritten@clayton.k12.ga.us
Expiration Date: 2019-07-31
Sent to Facility: 2017-11-28
Sent to Provost: 2018-03-16
Sent to Legal:
Completed: 2018-04-12
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:

 
AbsoluteCare Medical Center
Department of Nutrition
Alene Albritton
Phone: 404-231-4431 x122
2140 Peachtree Road Suite 232
Atlanta GA 30309
Agency Email: aalbritton@absolutecarehealth.com
Expiration Date: 2024-02-29
Sent to Facility: 2017-10-17
Sent to Provost: 2017-10-19
Sent to Legal:
Completed: 2021-04-16
Requester Name: Jessica Todd
Document 1: AbsoluteCare Medical Center
Document 2:
Document 3:

 
Dekalb Community Service Board-Winn Way Mental Health Center
School of Nursing
Renee Dryfoos
Phone: 404-508-7700
455 Winn Way Suite 220
Decatur GA 30030
Agency Email:
Expiration Date: 2018-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: Covered under the MOU with DCSB

 
Mill Creek Family Practice and Urgent Care, PC
School of Nursing
Roly Alvarez
Phone: 770-704-4911
7820 Hickory Flat Highway
Woodstock GA 30188
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-03-06
Sent to Provost: 2013-03-29
Sent to Legal:
Completed: 2013-05-01
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Visiting Nurse Health System
Byrdine F Lewis School of Nursing and Health Professions
Andrea Marks-Stevenson
Phone: 404-215-6092
5775 Glenridge Drive, NE Suite E200
Atlanta GA 30328
Agency Email: andrea.stevenson@vnhs.org
Expiration Date: 2017-04-30
Sent to Facility: 2019-05-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:

 
Creative Care Concepts, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Karen Cheeseman
Phone: 770-478-6091
3889 Easy Circle
Marietta GA 30066
Agency Email: kcheeseman@creativecareconcepts.com
Expiration Date:
Sent to Facility: 2019-05-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Creative Care Concepts MOU May 2019
Document 2:
Document 3:
Comment: 6/13/19 LYW Requested contract from Jennifer Brooks

 
Helping Hands Outreach Clinic
Byrdine F Lewis School of Nursing and Health Professions
Janice Morris
Phone: 678-607-0759
1733 Lake Rockaway Road NW
Conyers GA 30012
Agency Email: jmorris.hhoc@gmail.com
Expiration Date:
Sent to Facility: 2019-05-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Do not mail MOU; please forward MOU to Lisa Williams via e- mail for delivery to the site. 5/7/19 to Lisa Williams

 
Fulton County Department of Housing & Human Services
Nutrition
Joe Engelbird
Phone: 404-612-3404
265 Boulevard, NE Fourth Floor, Cubicle 36
Atlanta GA 30312
Agency Email: joe.engelbird@fultoncountyga.gov
Expiration Date:
Sent to Facility: 2017-09-14
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Renewal was sent to Sarah Hilton in April but she no longer works there. Joe Engelbird said he can route it to correct person. new mou mailed out

 
Internal Medicine Associates of Rockdale
School of Nursing
Judy Smith
Phone: 770-922-3038 x 149
1301 Wellbrook Circle, NE
Conyers GA 30012
Agency Email:
Expiration Date: 2014-12-31
Sent to Facility: 2012-01-12
Sent to Provost: 2012-01-24
Sent to Legal:
Completed: 2012-02-08
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:

 
Family Practice Partners, LLC
School of Nursing
Ian Holder-Ewing
Phone: 770-761-0501
1910 Hwy 20, SE Suite 270
Conyers GA 30013
Agency Email:
Expiration Date:
Sent to Facility: 2013-11-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Attempted to follow up, no working phone number available

 
Positive Balance Wellness Center
Byrdine F Lewis School of Nursing and Health Professions
Angela Shannon
Phone: 404-647-9478
2031 Austin Road
Atlanta GA 30331
Agency Email: positivebalancewellness@gmail.com
Expiration Date: 2022-07-31
Sent to Facility: 2019-08-07
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp july 2022 ...4122415pdf
Document 2:
Document 3:

 
Keating Family Medicine
School of Nursing
Barbara Smart
Phone: 706-265-4100
1080 Lumpkin Campground Road Dawsonville GA 30534
Agency Email:
Expiration Date:
Sent to Facility: 2012-07-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:

 
Princeton Lakes Internal Medicine
Byrdine F Lewis School of Nursing and Health Professions
Cassandra Treadway
Phone: 404-344-0059
3885 Princeton Lakes Way Suite 300
Atlanta GA 30331
Agency Email:
Expiration Date: 2015-01-31
Sent to Facility: 2012-01-20
Sent to Provost: 2012-01-20
Sent to Legal:
Completed: 2012-3-05
Requester Name: Janet Dortch
Document 1: view
Document 2:
Document 3:

 
Dr. Joseph H Martin, MD, LLC
School of Nursing
Joseph H. Martin
Phone: 404-526-9111
550 Peachtree Street Suite 1420
Atlanta GA 30308
Agency Email:
Expiration Date:
Sent to Facility: 2013-09-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: MOU hand delivered by Sheryl

 
South Dekalb Pediatrics Inc
School of Nursing
Nettia Gardner
Phone: 404-243-9630
2855 Candler Road Suite 9
Decatur GA 30034
Agency Email: ngardner@southdekalbpediatrics.com
Expiration Date: 2021-04-30
Sent to Facility: 2018-03-12
Sent to Provost: 2018-03-23
Sent to Legal:
Completed: 2018-04-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Marshall University, School of Medicine, Department of Pharmacology, Physiology and Toxicology
Department of Nutrition
Nalini Santanam
Phone: 304-696-7321
1700 3rd Avenua 435S BBSC
Huntington WV 25755
Agency Email:
Expiration Date: 2015-04-30
Sent to Facility: 2012-02-15
Sent to Provost: 2012-05-07
Sent to Legal:
Completed: 2012-05-23
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Marietta City School District
Department of Nutrition
Cindy Culver
Phone: 770-429-3107 x114
145 Dodd Street
Marietta GA 30060
Agency Email: cculver@marietta-city.k12.ga.us
Expiration Date: 2023-08-15
Sent to Facility: 2017-04-21
Sent to Provost: 2017-09-13
Sent to Legal:
Completed: 2017-11-2
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement

 
Georgia Organics
Department of Nutrition
Andrew Ladd
Phone: 678-702-0400 x202
200 A Ottley Drive Suite A
Atlanta GA 30324
Agency Email: kimberly@georgiaorganics.org
Expiration Date: 2017-07-31
Sent to Facility: 2020-06-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical Kimberly Della Donna kimberly@georgiaorganics.org is the contact

 
Pediatric Health Center
BFLCNHP
Sheldon Stewart
Phone: 7704834431
2213 Exchange Place - Suite A
Conyers GA 30013
Agency Email: Sheldon@pediatrichcenter.com
Expiration Date: 2022-05-31
Sent to Facility: 2019-06-18
Sent to Provost: 2019-07-02
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: 6/18/19 Renewal initiated 7/2/19 Mr. Stewart crossed out Dunwooody, sent email inquiring 7/2/19 Covers Conyers location only, as of 8/1/2016 they are not affiliated with Dunwoody location.

 
Housing Authority of the City of Atlanta
School of Nursing
Howard Grant
Phone: 404-817-7347
230 John Wesley Dobbs Avenue
Atlanta GA 30303-2421
Agency Email: howard.grant@atlantahousing.org
Expiration Date: 2018-07-31
Sent to Facility: 2018-07-06
Sent to Provost: 2018-07-23
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/18/18 Facility sent an amendment, 7/23/18 forwarded amendment and renewal letter to C. Lombard. 8/14/18 to facility for signature

 
Cherokee Family Medical Center
BFLCNHP
Jackie Williamson
Phone: 770-926-9846
9766 Highway 92 Suite 200
Woodstock GA 30188
Agency Email: CherokeeFamilyMed@gmail.com
Expiration Date: 2024-01-31
Sent to Facility: 2018-01-04
Sent to Provost: 2018-01-30
Sent to Legal:
Completed: 2021-07-06
Requester Name: Lisa Williams
Document 1: Cherokee Family Medical Center
Document 2:
Document 3:
Comment: complete

 
Archbold Northside Center for Behavioral and Psychiatric Care
School of Nursing
Jim Terry
Phone: 229-228-8100
P. O. Box 1018
Thomasville GA 31799-1018
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-02-12
Sent to Provost: 2013-03-12
Sent to Legal:
Completed: 2012-03-13
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: Agreement already established as John D. Arcbold Memorial Hospital

 
Take Care Health Systems, LLC
School of Nursing
Stephanie Cinfio
Phone: 847-315-8220
200 Wilmt Road
Deerfield IL 60015-4620
Agency Email: stephanie.cinfio@walgreens.com
Expiration Date: NO EXPIRATION DATE
Sent to Facility: 2016-05-31
Sent to Provost: 2016-09-01
Sent to Legal:
Completed: 2016-09-12
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Either party may terminate at any time with 30 days written notice.

 
Pediatric Center for Wellness
School of Nursing
Crystal Hood
Phone: 904-887-1253
1506 Klondike Road Suite 205
Conyers GA 30094
Agency Email: abcdefg
Expiration Date: 2015-03-31
Sent to Facility: 2012-05-02
Sent to Provost: 2012-05-04
Sent to Legal:
Completed: 2012-05-16
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Sensory Scaffoldings Pediatric Therapy, Inc.
Department of Occupational Therapy
Ben Wessels
Phone: 678-314-2907
225 Lansdowne Ave.
Decatur GA 30030
Agency Email: bwessels@gmail.com
Expiration Date: 2020-11-30
Sent to Facility: 2020-09-02
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Please cc Shana Finks sfinks@gsu.edu

 
Community Farmers Markets
Department of Nutrition
Katie Hayes
Phone: 404-919-3619
508 Flat Shoals Avenue Atlanta GA 30316
Agency Email:
Expiration Date:
Sent to Facility: 2012-05-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Atlanta Headache Specialists
School of Nursing
Frank R Berenson
Phone: 678-313-7536
5887 Glenridge Drive NE Suite 140
Atlanta GA 30342
Agency Email:
Expiration Date:
Sent to Facility: 2012-05-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1:
Document 2:
Document 3:

 
Salvation Army Red Shield
Department of Occupational Therapy
Jane Lee
Phone: 678 418-4636
1000 Center Place NW Social Services Department
Norcross Georgia 30636
Agency Email: Jane.Lee@uss.salvationarmy.org
Expiration Date:
Sent to Facility: 2017-12-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: I have sent you an email regarding this request and I left some informaiton on your desk. Please call me on this one wiwth any questions you may have. emailed

 
University Gynecologic Oncology
School of Nursing
Kenya Sampler
Phone: 404-300-2990
960 Johnson Ferry Road Suite 130
Atlanta GA 30342
Agency Email:
Expiration Date:
Sent to Facility: 2012-05-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Janet Dortch Dortch
Document 1:
Document 2:
Document 3:

 
Community Health Center, Inc.
School of Nursing
David Aten
Phone: 678-398-6548
6289 Veterans Memorial Pkwy Suite 12-C
Austell GA 30168
Agency Email: zach.aten@chcaustell.org
Expiration Date: 2018-05-31
Sent to Facility: 2015-03-12
Sent to Provost: 2015-03-12
Sent to Legal:
Completed: 2015-03-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 6/1/18 Unable to establish contact with this clinic. When new contact is determined, will need to send new MOU. Current expired 5/31/18. 6/27/18 Clinic appears to be closed for renovation. Per Lisa, she will contact the clinic in the fall to see about re-establishing the contract. 10/4/2018 - the site is still closed and not serving patients. Will follow up in November. LYW

 
Panda Neurology
School of Nursing
Jennifer Taylor
Phone: 678-705-7341
5887 Glenridge Drive Suite 140
Sandy Springs GA 30328
Agency Email:
Expiration Date: 2018-05-31
Sent to Facility: 2015-03-10
Sent to Provost: 2015-03-20
Sent to Legal:
Completed: 2015-04-03
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
The University of Texas MD Anderson Cancer Center
Department of Respiratory Therapy
Jeanne Wiggins
Phone: 713-792-2529
Legal Sevices - Unit 537 P. O. Box 301439
Houston TX 77030-1439
Agency Email:
Expiration Date: 2015-12-31
Sent to Facility: 2013-05-16
Sent to Provost: 2013-07-23
Sent to Legal:
Completed: 2012-08-14
Requester Name: Douglas Gardenhire
Document 1:
Document 2:
Document 3:
Comment: Amendment fully executed

 
Just For You Womens Healthcare
BFLCNHP
Briana Johnson
Phone: 678-814-4700
3976 Highway 42 South
Locust Grove GA 30248
Agency Email: briana@justforyouobgyn.com
Expiration Date: 2024-09-30
Sent to Facility: 2015-05-07
Sent to Provost: 2015-09-08
Sent to Legal:
Completed: 2021-10-20
Requester Name: Lisa Williams
Document 1: Just For You Womens Healthcare
Document 2:
Document 3:
Comment:

 
Fieldale Farms Family Health Center
School of Nursing
Patty Thomas
Phone: 706-894-2714
184-A Professional Drive
Baldwin GA 30511
Agency Email:
Expiration Date: auto renew
Sent to Facility: 2012-07-05
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-12-08
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:
Comment: no expiration date. auto renew

 
Mednax Northside Womens Specialists
School of Nursing
Corey Poindexter
Phone: 404-255-2057
980 Johnson Ferry Road
Atlanta GA 30342
Agency Email: Corey_poindexter@mednax.com
Expiration Date: 2020-09-30
Sent to Facility: 2020-08-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/4/2020 - updated practice administrator information and resent contract. LYW

 
Smart Primary Care
School of Nursing
Jacqueline Babe
Phone: 770-884-4402
696 Grayson Highway
Lawrenceville GA 30046
Agency Email: jbabe@smartcareuc.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-26
Sent to Provost: 2017-11-21
Sent to Legal:
Completed: 2017-12-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/22/20 - Smart Primary Care is a private practice member of the Emory Healthcare Network. Covered under Emory MOU.

 
Pediatric Neurosurgery Associates
School of Nursing
Ryan Bowcut
Phone: 404-785-2932
5455 Meridian Mark Road Suite 540
Atlanta GA 30342
Agency Email:
Expiration Date: 2014-07-31
Sent to Facility: 2012-08-14
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1:
Document 2:
Document 3:
Comment: MOU covered under CHOA agreement

 
University Medical Group-Internal Medicine Partners
School of Nursing
Wanda Schronce
Phone: 706-792-5085
3121 Peach Orchard Road Suite 103
Augusta GA 30906
Agency Email:
Expiration Date:
Sent to Facility: 2012-07-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:

 
Tri County Internal Medicine PC
BFLCNHP
Sue Coker
Phone: 770-945-1990
4720 Nelson Brogdon Boulevard
Sugar Hill GA 30518
Agency Email: scoker@tricountymedicine.com
Expiration Date: 2020-08-31
Sent to Facility: 2020-07-22
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/22/2020 per facility they are not taking new students for the foreseeable future. Kelli

 
The Vashti Center, Inc.
School of Nursing
Catherine Marchant
Phone: 229-226-4634
1815 East Clay Street
Thomasville GA 31792
Agency Email:
Expiration Date:
Sent to Facility: 2012-08-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: Facility cannot accommodate our request

 
Horizons Healthcare
School of Nursing
Jody Amazon
Phone: 770-985-8001
2795 Main Street, W Suite 27
Snellville GA 30078
Agency Email: jamazon@bellsouth.net
Expiration Date:
Sent to Facility: 2014-11-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: MOU e-mailed

 
La Clinica Materna Infantil
BFLCNHP
Daliah Koredjian
Phone: 770-734-0999
2090 Beaver Ruin Road Suite 800
Norcross GA 30071
Agency Email: DKoredjian@gmail.com
Expiration Date: 2015-08-31
Sent to Facility: 2012-08-09
Sent to Provost: 2012-08-15
Sent to Legal:
Completed: 2012-08-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Centre Spring MD
School of Nursing
Jessica Hoot
Phone: 404-814-9808
1410 Dresden Drive
Atlanta GA 30319
Agency Email: admin@centrespringmd.com
Expiration Date: 2020-04-30
Sent to Facility: 2020-03-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/15/20 marked inactive per LW, facility never responded.

 
Bishop Physical Therapy
Department of Physical Therapy
Daniel Bishop
Phone: 251-626-7778
1203 US 98 #1
Daphne AL 36526
Agency Email: bishop.pt@aol.com
Expiration Date: 2015-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires May 2022
Document 2:
Document 3:

 
Cantrell Center for Physical Therapy
Department of Physical Therapy
Mary Oakley
Phone: 478-953-3535 x107
405 Osigian Blvd
Warner Robins GA 31088
Agency Email: clinical@cantrellcenter.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-11-14
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Carla Huggins
Document 1: Expires April 2020 Cantrell_001
Document 2:
Document 3:
Comment: Please copy Michelle Straw: execasst@cantrellcenter.com

 
In Touch Therapy
Department of Physical Therapy
Harrison Vaughn
Phone: 434-447-3322
1187 N. Mecklenburg Avenue South Hill VA 23970
Agency Email:
Expiration Date: 2015-08-31
Sent to Facility: 2012-09-05
Sent to Provost: 2012-09-27
Sent to Legal:
Completed: 2012-10-09
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:

 
NCR Corporation
Department of Nutrition
Michelle Green
Phone: 678-808-7399
3097 Satellite Blvd Duluth GA 30096
Agency Email:
Expiration Date:
Sent to Facility: 2012-09-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
HighPoint Family Practice
School of Nursing
Wendy Parrish
Phone: 678-583-8388
886 Hampton Road
McDonough GA 30253
Agency Email: wendywalton@bellsouth.net
Expiration Date: 2018-08-31
Sent to Facility: 2019-12-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 12/9 Please renew. LYW

 
Georgia Christian Medical LLC
School of Nursing
Rena Turner
Phone: 706-798-4673
2604 Peach Orchid Road Suite 200
Augusta GA 30906
Agency Email:
Expiration Date: 2015-08-30
Sent to Facility: 2012-09-13
Sent to Provost: 2012-09-17
Sent to Legal:
Completed: 2012-09-26
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: THIS FACILITY IS CLOSED.

 
Psychiatric Consultants of Atlanta, PC
School of Nursing
Liz Norman
Phone: 770-234-0981
900 Hammond Drive Suite 525
Sandy Springs GA 30328
Agency Email: psychiatric.consultants@yahoo.com
Expiration Date: 2022-09-30
Sent to Facility: 2019-09-25
Sent to Provost: 2019-10-01
Sent to Legal:
Completed: 2019-10-03
Requester Name: Lisa Williams
Document 1: Final Expires Sept 2022
Document 2:
Document 3:

 
Murray Medical and Wellness Center
BFLCNHP
Jasmine S. Walker
Phone: 404-549-9471
920 Dannon View
Atlanta GA 30331
Agency Email: murraymedicalcenter@yahoo.com
Expiration Date: 2024-10-31
Sent to Facility: 2018-08-01
Sent to Provost: 2018-08-02
Sent to Legal:
Completed: 2022-01-20
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
Advanced Surgical Weight Loss Center
Department of Nutrition
Katelyn Crews
Phone: 205-716-6111
860 Montclair Road Suite 625
Birmingham AL 35213
Agency Email:
Expiration Date: 2015-09-30
Sent to Facility: 2012-09-17
Sent to Provost: 2012-09-20
Sent to Legal:
Completed: 2012-10-17
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Longleaf Hospice
School of Nursing
E. Raina Owens
Phone: 770-939-9179
2712 Lawrenceville Highway Suite 200
Decatur GA 30033
Agency Email:
Expiration Date:
Sent to Facility: 2012-09-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: JoAnn Bacon
Document 1:
Document 2:
Document 3:

 
Dr. Michelle R. Martin, MD, LLC
School of Nursing
Michelle R. Martin
Phone: 770-980-1110
2550 Windy Hill Road Suite 106
Marietta GA 30067
Agency Email: mrm.obgyn@gmail.com
Expiration Date: 2018-09-30
Sent to Facility: 2015-06-02
Sent to Provost: 2015-07-13
Sent to Legal:
Completed: 2015-07-21
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:

 
Womencare, P.C.
School of Nursing
Karen Stuart
Phone: 706-322-4950
1201 18th Street
Columbus GA 31901
Agency Email:
Expiration Date: 2018-09-30
Sent to Facility: 2015-06-02
Sent to Provost: 2015-06-02
Sent to Legal:
Completed: 2015-06-09
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:

 
One Drop Farm
Department of Nutrition
Ann Mefferd
Phone: 207-853-3033
300 Beckwith Road Cornville ME 04976
Agency Email:
Expiration Date: 2015-10-31
Sent to Facility: 2012-10-11
Sent to Provost: 2012-10-20
Sent to Legal:
Completed: 2012-11-06
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Dr. V. Sharon Jones, MD
School of Nursing
Deanna Cummings
Phone: 706-647-1200
211 E. Thompson Street
Thomaston GA 30286
Agency Email: drvsharonjones@dr.com
Expiration Date: 2015-09-30
Sent to Facility: 2015-08-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
UPAC of Decatur
Department of Nutrition
Stephanie Vera
Phone: 404-212-3400
3200 Pantherville Road
Decatur GA 30034
Agency Email:
Expiration Date:
Sent to Facility: 2012-10-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: MOU approved sent to OLA for sigs 2/19/13;new red-lined changes sent to UPAC.Requested review from Caroline 4/25/14

 
Morehouse School of Medicine, Clinical Research Center
Department of Nutrition
Kayellen Umeakunne
Phone: 404-752-1010
720 Westview Drive, SW Room G11 MRC Building
Atlanta GA 30310
Agency Email: kumeakunne@msm.edu
Expiration Date: 2020-04-30
Sent to Facility: 2017-02-15
Sent to Provost: 2017-03-30
Sent to Legal:
Completed: 2017-04-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical

 
Thomaston Medical Clinic, PC
School of Nursing
Christy Winkles
Phone: 706-647-2147
615 South Center Street Thomaston GA 30286
Agency Email:
Expiration Date:
Sent to Facility: 2012-10-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Janet Dortch
Document 1:
Document 2:
Document 3:

 
Dr. Manuel Patino
School of Nursing
Brad Harris
Phone: 404-352-1223
3193 Howell Mill Road NW Suite 204
Atlanta GA 30327
Agency Email:
Expiration Date:
Sent to Facility: 2012-11-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Frisco Medical Surgical Clinic #2
School of Nursing
Victoria L. Tyra
Phone: 972-542-5811
1505 Harroun Avenue Suite C
McKinney TX 75069
Agency Email:
Expiration Date: 2015-11-30
Sent to Facility: 2012-11-13
Sent to Provost: 2012-11-16
Sent to Legal:
Completed: 2012-12-17
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:
Comment: Clinic is Closing Permanently on September 1, 2015.

 
West Cobb Internal Medicine, PC
School of Nursing
Conda Bostick
Phone: 770-218-1088
5077 Dallas Highway Suite 315
Powder Springs GA 31027
Agency Email:
Expiration Date:
Sent to Facility: 2012-11-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: DOES NOT WISH TO PARTICIPATE

 
Emir Primary Care
BFLCNHP
Charles Jenkins
Phone: 404-366-3647
4930 Governors Drive Suite 401
Forest Park GA 30297
Agency Email: cjenkinsrn@gmail.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-01-17
Sent to Provost: 2019-01-28
Sent to Legal:
Completed: 2022-03-03
Requester Name: Lisa Williams
Document 1: Final Expires Feb 2022
Document 2:
Document 3:

 
South Atlanta Urgent Care Clinic
School of Nursing
Eva Beaulieu
Phone: 404-763-9300
5185 Old National Hwy
Atlanta GA 30349
Agency Email: evabeaulieu@gmail.com
Expiration Date: 2015-11-30
Sent to Facility: 2012-12-10
Sent to Provost: 2012-12-14
Sent to Legal:
Completed: 2012-12-20
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
Comment: Does Not wish to Renew at this time. Will not be accepting student Nurses until Fall 2016.

 
Jefferson Pediatrics
School of Nursing
Dana Irwin
Phone: 706-367-1010
2610 US Hwy 129 N. Jefferson GA 30549
Agency Email:
Expiration Date:
Sent to Facility: 2012-12-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Myra Carmon
Document 1:
Document 2:
Document 3:

 
Phoebe Putney Health System, Inc.
BFLCNHP
Melanie Finlayson
Phone: 229-312-1072
417 Third Avenue
Albany GA 31701
Agency Email: mfinlays@phoebehealth.com
Expiration Date: 2022-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-10-01
Sent to Legal:
Completed: 2019-10-03
Requester Name: Lisa Williams
Document 1: Final Expires August 2022
Document 2:
Document 3:
Comment: The following should be included in the contract: Facility: Phoebe Putney Health System, Inc. Facility Signature: Joe Austin, EVP/COO With a Copy to Facility Legal Counsel at: Phoebe Putney Health System, Inc. Office of General Counsel 417 W. Third Avenue Albany, GA 31701

 
Interventional Spine and Pain Management
Department of Nutrition
Marcy Steinberg
Phone: 404-386-9135
3400 Peachtree Road, NE Suite 811
Atlanta GA 30326
Agency Email:
Expiration Date: 2015-12-31
Sent to Facility: 2013-01-08
Sent to Provost: 2013-01-18
Sent to Legal:
Completed: 2013-01-29
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Dr. Sanjeeva H. Rao, MD
School of Nursing
Sanjeeva H. Rao
Phone: 770-227-7758
691 South 8th Street Griffin GA 30224
Agency Email:
Expiration Date:
Sent to Facility: 2013-01-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Cancer Services
Department of Nutrition
Julie Lanford
Phone: 336-760-9983
3175 Maplewood Avenue Winston-Salem NC 27103
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-01-16
Sent to Provost: 2013-01-24
Sent to Legal:
Completed: 2013-02-08
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Hypertension & Kidney Care of North Atlanta
School of Nursing
Trovis Robertson
Phone: 770-491-1344
1350 Montreal Road Suite
Tucker GA 30084
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-01-23
Sent to Provost: 2013-02-04
Sent to Legal:
Completed: 2013-02-19
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
North Georgia Health District
School of Nursing
John D. Kennedy
Phone: 706-272-2342
100 West Walnut Avenue Suite 92
Dalton GA 30720
Agency Email: dlrobbins@dhr.state.ga.us
Expiration Date: 2017-01-31
Sent to Facility: 2014-02-10
Sent to Provost: 2015-03-11
Sent to Legal:
Completed: 2015-03-26
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Total Care Family Medicine PC
School of Nursing
Kelvin Burton
Phone: 770-942-1044
2022 Fairburn Road Suite D
Douglasville GA 30134
Agency Email: mthomas@totalcarefam.comcastbiz.net
Expiration Date: 2019-01-31
Sent to Facility: 2018-11-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
Comment: Ms. Millicent Thomas is the Office Manager and will answer the email.

 
Capstone Medical Group, PC
School of Nursing
Nara Watson
Phone: 404-446-3870
5900 Hillandale Drive Suite 200
Lithonia GA 30058
Agency Email:
Expiration Date:
Sent to Facility: 2013-01-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
The Medical Offices of North Georgia
School of Nursing
Stephanie McDonald
Phone: 706-698-4362
822 Industrial Blvd Ellijay GA 30540
Agency Email:
Expiration Date:
Sent to Facility: 2013-02-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Captain Planet Foundation
Department of Nutrition
Kyla Van Deusen
Phone: 404-522-4270
133 Luckie Street 2nd Floor
Atlanta GA 30303
Agency Email: kyla@captainplanetfdn.org
Expiration Date: 2019-01-31
Sent to Facility: 2016-01-04
Sent to Provost: 2016-01-05
Sent to Legal:
Completed: 2016-01-22
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical agreement.

 
Northwest Georgia Oncology Centers, P.C.
School of Nursing
Pat McDole
Phone: 678-331-3301
531 Roselane Street Suite 710
Marietta GA 30060
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-02-06
Sent to Provost: 2013-02-11
Sent to Legal:
Completed: 2013-02-27
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Georgia Long Term Care Family Practice
Williams
Yolanda Frinks
Phone: 770-938-1757
1990 Lakeside Parkway # 170
Tucker GA 30084
Agency Email: yfrinks@gltcmedical.com
Expiration Date: 2022-01-31
Sent to Facility: 2018-11-21
Sent to Provost: 2019-02-06
Sent to Legal:
Completed: 201-02-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:

 
Mission Columbus Medical Clinic
School of Nursing
Wayne Gallups
Phone: 706-507-4687
3679 Steam Mill Road
Columbus GA 31906
Agency Email:
Expiration Date: 2016-01-31
Sent to Facility: 2013-02-07
Sent to Provost: 2013-02-11
Sent to Legal:
Completed: 2013-02-19
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Northeast Georgia Diagnostic Clinic, LLC
School of Nursing
Katrina Bailey
Phone: 770-531-3301
1240 Jesse Jewel Parkway Suite 500
Gainesville GA 30501
Agency Email: Katrina.bailey@ngdc.com
Expiration Date: 2016-01-31
Sent to Facility: 2019-12-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 12/19 - This is a Northside affiliated practice and covered under the contract with Northside Hospital. LYW

 
Immediate Care Centers of Georgia
School of Nursing
Ray Bennett
Phone: 770-692-7575
190 Greencastle Road
Tyrone GA 30290
Agency Email:
Expiration Date: 2016-02-29
Sent to Facility: 2013-02-14
Sent to Provost: 2013-02-15
Sent to Legal:
Completed: 2013-02-28
Requester Name: Eva Horne
Document 1: view
Document 2:
Document 3:

 
Bethesda Community Clinic
School of Nursing
Melissa Belfield
Phone: 678-880-9654
117 Mountain Brook Drive Suite 100
Canton GA 30115
Agency Email: director@bcccherokee.com
Expiration Date: 2023-07-31
Sent to Facility: 2020-08-10
Sent to Provost: 2020-08-13
Sent to Legal:
Completed: 2020-08-19
Requester Name: Lisa Williams
Document 1: ExpJul2023 BethesdaCommClinic_Aug2020 - signed
Document 2:
Document 3:

 
SouthernHealth Corporation of Ellijay
School of Nursing
Debbie Self
Phone: 706-635-5177x6062
1362 South Main Street Ellijay GA 30540
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-02-19
Sent to Provost: 2013-04-19
Sent to Legal:
Completed: 2013-05-09
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: North Georgia Medical Center

 
John W. Houser
School of Nursing
John W. Houser
Phone: 404-699-1353
2600 Martin Luther King Jr. Drive, SW Suite 200
Atlanta GA 30311
Agency Email:
Expiration Date: 2016-02-29
Sent to Facility: 2013-02-22
Sent to Provost: 2013-02-22
Sent to Legal:
Completed: 2/28/2013
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Stay Well Pediatrics
BFLCNHP
Neha Soni
Phone: 678-248-2350
6286 Oakwood Circle
Norcross GA 30093
Agency Email: staywellpediatrics@gmail.com
Expiration Date: 2025-02-28
Sent to Facility: 2016-11-29
Sent to Provost: 2016-12-01
Sent to Legal:
Completed: 2022-03-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Trion Medical Center
School of Nursing
Robyn Shepard
Phone: 706-734-2003
P. O. Box 880 701 Allgood Street
Trion GA 30753
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-02-26
Sent to Provost: 2013-03-04
Sent to Legal:
Completed: 2013-03-26
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Perimeter Pediatric Clinic
School of Nursing
Thomas Adamkiewicz
Phone: 770-458-3383
3020 Mercer university Drive Suite 100
Atlanta GA 30341
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-03-05
Sent to Provost: 2013-03-26
Sent to Legal:
Completed: 2013-04-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
XLHome, PC
School of Nursing
Nicole Alvarado
Phone: 704-892-7990
6514 Meadowridge Road
Elkridge MD 21075
Agency Email:
Expiration Date: 2014-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 10/16/2013
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Delta Pediatrics
BFLCNHP
Emanuel Mordi
Phone: 678-765-6749
3966 South Bogan Road Bldg B
Buford GA 30519
Agency Email: info@deltapediatrics.com
Expiration Date: 2024-09-30
Sent to Facility: 2013-03-07
Sent to Provost: 2013-05-17
Sent to Legal:
Completed: 2013-05-24
Requester Name: Lisa Williams
Document 1: Delta Pediatrics
Document 2:
Document 3:

 
Aquila Ltd.
Department of Nutrition
Lauren Korzan
Phone: 404-639-2164
1600 Clifton Road, NE MS F-06
Atlanta GA 30333
Agency Email:
Expiration Date: 2016-03-31
Sent to Facility: 2013-03-08
Sent to Provost: 2013-03-25
Sent to Legal:
Completed: 2013-04-03
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Pediatric Primary Care Associates
School of Nursing
Clay Stallworth
Phone: 706-312-5437
905 15th Street Augusta GA 30901
Agency Email:
Expiration Date:
Sent to Facility: 2013-03-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Only wants to work with this one student;sending to practic mgrs for sigs 3/22/13

 
Med Now Inc.
School of Nursing
Gary Crews
Phone: 706-275-4444
2709 Airport Road Suite 101
Dalton GA 30721
Agency Email:
Expiration Date: 2016-04-30
Sent to Facility: 2013-04-11
Sent to Provost: 2013-04-16
Sent to Legal:
Completed: 2013-05-01
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Physical Therapy In Motion
Department of Physical Therapy
Coy Leverette
Phone: 770-288-2441
106 Vinings Drive
McDonough GA 30253
Agency Email: coy@ptmotioninc.com
Expiration Date: 2016-04-30
Sent to Facility: 2015-11-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Ivy League Pediatrics, LLC
School of Nursing
Natalie Celestin
Phone: 678-407-4489
601 Old Norcross Road Lawrenceville GA 30046
Agency Email:
Expiration Date:
Sent to Facility: 2013-04-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: NOT PARTICIPATING

 
Godel First Medical Clinic
School of Nursing
Ellis Efobi
Phone: 770-879-7707
1525 E. Park Place Blvd Suite 300
Stone Mountain GA 30087
Agency Email:
Expiration Date:
Sent to Facility: 2013-04-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: NOT PARTICIPATING

 
Hamilton Mill Pediatrics
School of Nursing
Robert Thompson
Phone: 770-513-8882
3619 Braselton Hwy Suite 103
Dacula GA 30019
Agency Email: email@hamiltonmillpediatrics.com
Expiration Date: 04/30/2021
Sent to Facility: 2018-03-12
Sent to Provost:
Sent to Legal:
Completed: 2018-06-08
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: renwal sent 3/12/18 6/8/18 Renewal complete. Emailed all parties

 
ProDiagnostics Medical Center
BFLCNHP
Lina Arango
Phone: 678-915-1891
6460 Hwy 92 Suite 200
Acworth GA 30102
Agency Email: lina@prodiagnosticsacworth.com
Expiration Date: 2025-07-31
Sent to Facility: 2019-07-25
Sent to Provost: 2019-08-05
Sent to Legal:
Completed: 2022-06-17
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:

 
Healthy Steps Pediatrics, LLC
BFLCNHP
Mary Hammock
Phone: 678-384-3480
3911 Mary Eliza Trace NW Suite 200
Marietta GA 30064
Agency Email: msmary@pediatrics4u.com
Expiration Date: 2025-07-31
Sent to Facility: 2019-07-25
Sent to Provost: 2019-08-12
Sent to Legal:
Completed: 2022-08-08
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:

 
Opulent Pediatrics
School of Nursing
Doug Liggion
Phone: 404-499-9131
428 Winn Court
Decatur GA 30030
Agency Email:
Expiration Date: 2016-04-30
Sent to Facility: 2013-05-01
Sent to Provost: 2013-05-15
Sent to Legal:
Completed: 2013-05-24
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Tri-County Pediatrics
School of Nursing
Melina Emmanuelli
Phone: 770-389-0116
193 North Park Trail Suite 100
Stockbridge GA 30281
Agency Email: memmanuelli@tricountypediatrics.com
Expiration Date: 2019-05-31
Sent to Facility: 2016-05-18
Sent to Provost: 2016-05-20
Sent to Legal:
Completed: 2016-06-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/22/19 - the practice is not taking students. LYW Covers Stockbridge, Fayetteville and Riverdale Offices.

 
Pediatric Associates of Johns Creek, PC
School of Nursing
Stacy Cragg
Phone: 770-476-4020
4310 Johns Creek Parkway Suite 150
Suwanee GA 30024
Agency Email:
Expiration Date: 2019-05-31
Sent to Facility: 2016-05-24
Sent to Provost: 2016-05-25
Sent to Legal:
Completed: 2016-06-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Manning Pediatrics, LLCManning Pediatrics, LLC
School of Nursing
Audrey Cann
Phone: 770-786-0012
4139 Hospital Blvd.
Covington GA 30014
Agency Email:
Expiration Date: 2016-04-15
Sent to Facility: 2013-05-09
Sent to Provost: 2013-05-10
Sent to Legal:
Completed: 2013-05-22
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Decatur Pediatric Group
BFLCNHP
Emily Curia
Phone: 404-296-7133
5424 Hillandale Park Ct Suite A
Lithonia GA 30058
Agency Email: Curia.Emily@gmail.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed: 2022-03-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Additional Locations: Clarkston, Covington, Smyrna

 
Stepping Stones Intervention Services
Department of Occupational Therapy
Dawn Jones
Phone: 678-545-6745
2759 Mount Zion Parkway Suite A
Jonesboro GA 30236
Agency Email: steppingstonesinterventions@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Shana Finks
Document 1: exp dec 2022 ...4122245.pdf
Document 2:
Document 3:
Comment: If possible, please expedite this contract. The student would be starting 2/10/20. Thank you so much! -Letitia Carelock lcarelock@gsu.edu.

 
Atlas Internal Medicine
Byrdine F Lewis School of Nursing and Health Professions
Richard Stevens
Phone: 229-273-8501
201 16th Avenue East
Cordele GA 31015
Agency Email: DrStevens@atlasinternalmedicine.com
Expiration Date:
Sent to Facility: 2019-10-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Cedar Creek Pediatrics, PC
School of Nursing
Jack Rogers, Jr.
Phone: 678-901-0717
114 Plantation Avenue
Cedartown GA 30125-2370
Agency Email:
Expiration Date: 2024-03-31
Sent to Facility: 2013-05-24
Sent to Provost: 2013-06-03
Sent to Legal:
Completed: 2021-07-06
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Sewell Family Medicine
School of Nursing
Mary Cammack
Phone: 404-297-1818
8225 Mall Parkway Suite 250
Lithonia GA 30038
Agency Email:
Expiration Date:
Sent to Facility: 2013-06-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: IS NOW STONECREST PEDIATRICS & ADULT MEDICINE

 
Star Family Healthcare
School of Nursing
Helen Uzokwe
Phone: 770-510-3766
5337 Old National Hwy
College Park GA 30349
Agency Email: Huzokwe@starfamilyhealthCare.com
Expiration Date: 2022-08-31
Sent to Facility:
Sent to Provost: 2019-08-30
Sent to Legal:
Completed: 2019-09-16
Requester Name: Lisa Williams
Document 1: Final Expires August 2022
Document 2:
Document 3:

 
Mercy Hospital-Springfield
Department of Physical Therapy
Karen Kyle
Phone: 417-820-2772
1235 E Cherokee
Springfield MO 65804
Agency Email: Karen.Kyle@Mercy.Net
Expiration Date: Auto Renews
Sent to Facility: 2019-01-31
Sent to Provost: 2019-01-09
Sent to Legal:
Completed: 2019-11-21
Requester Name: Carla Huggins
Document 1: Auto Renews
Document 2:
Document 3:
Comment: 12/19/18 updated contact information to K. Kyle 1/3/19 K. Kyle sent our agreement to their legal for review, they may want to use theirs. 1/9/19 facility sent agreement, to legal for review 1/30/19 Provost signed. Back to Facility for signature

 
Camp Creek Pediatrics
School of Nursing
Charlene Johnson
Phone: 404-349-6758
3886 Princeton Lakes Way Suite 260
Atlanta GA 30331
Agency Email:
Expiration Date: 2016-05-31
Sent to Facility: 2013-06-07
Sent to Provost: 2013-06-07
Sent to Legal:
Completed: 2013-06-14
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
MedLink Georgia, Inc.
BFLCNHP
Morgan McFarlin
Phone: 706-367-4455
2748 Winder Highway
Jefferson GA 30549
Agency Email: mmcfarlin@medlinkga.org
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost: 2021-12-09
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Driftwood Recovery
Byrdine F Lewis School of Nursing and Health Professions
Rebecca Wolpert
Phone: 713-449-4616
1905 Elder Hill Road
Driftwood TX 78619
Agency Email: Rwolpert@driftwoodrecovery.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Atlanta VA Medical Center-NT
Department of Nutrition
Wilma C West
Phone: 404-321-6111 x7445
Education Support Service Line (141) 1670 Clairmont Road
Decatur GA 30033
Agency Email:
Expiration Date:
Sent to Facility: 2013-10-15
Sent to Provost: 2013-10-22
Sent to Legal:
Completed: 2014-06-18
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: No Expiration Date.

 
Modern OB/GYN of Atlanta
School of Nursing
Ingrid Reyes
Phone: 404-446-2496
6335 Hospital Parkway Suite 204
Johns Creek GA 30097
Agency Email:
Expiration Date: 2016-06-30
Sent to Facility: 2013-06-24
Sent to Provost: 2013-07-30
Sent to Legal:
Completed: 2013-08-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Bethanys Equine and Aquatic Therapy Services, Inc.
Department of Physical Therapy
Bethany Nugent
Phone: 678-494-6616
1704 Winston Court
Woodstock GA 30189
Agency Email: bethany@beats-inc.org
Expiration Date: 2025-06-30
Sent to Facility: 2019-03-29
Sent to Provost: 2019-04-09
Sent to Legal:
Completed: 2022-03-22
Requester Name: Carla Huggins
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
Greystone OB/GYN
School of Nursing
Rosemarie Nowicki
Phone: 770-860-1133
3240 Avalon Blvd.
Conyers GA 30013
Agency Email: rosemarie@greystoneobgyn.com
Expiration Date: 2016-06-30
Sent to Facility: 2013-06-25
Sent to Provost: 2013-08-05
Sent to Legal:
Completed: 2013-09-06
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Angel Medical Center
Department of Nutrition
Teresa Breedlove
Phone: 828-369-4166
120 Riverview 3rd Floor
Franklin NC 28734
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-07-11
Sent to Provost: 2013-07-17
Sent to Legal:
Completed: 2013-07-30
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Center for Disease Control and Prevention; National Center for Chronic Disease and Stroke Prevention; Epidemiology and Surveillance Branch
Department of Nutrition
Mary Cogswell
Phone: 770-488-8053
4770 Buford Highway, NE Mailstop F-72
Chamblee GA 30341
Agency Email: mec0@cdc.gov
Expiration Date: 2016-07-31
Sent to Facility: 2016-05-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non-clinical agreement Renewal emailed. CDC is not renewing the agreement at this time.

 
University Hospital
School of Nursing
Laura Arthur
Phone: 706-774-8286
1350 Walton Way Augusta GA 30901-2612
Agency Email: LauraArthur@uh.org
Expiration Date: 2014-08-27
Sent to Facility: 2013-07-29
Sent to Provost: 2013-08-14
Sent to Legal:
Completed: 2013-08-27
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Contemporary Women's Healthcare, LLC
School of Nursing
Carmen McGee
Phone: 770-561-6249
367 Hwy 78 Suite 2300
Loganville GA 30052
Agency Email:
Expiration Date:
Sent to Facility: 2013-08-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: MOU e-mailed to Office Manager, Dennis;NOT PARTICIPATING

 
Perisseia Physicians, LLC
School of Nursing
Ashley Showalter
Phone: 770-682-2024
1655 Lebanon Road Suite A
Lawrenceville GA 30043
Agency Email:
Expiration Date: 2016-06-30
Sent to Facility: 2013-08-07
Sent to Provost: 2013-08-12
Sent to Legal:
Completed: 2013-08-17
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Family Heritage Foundation
School of Nursing
Bennett Ekandem
Phone: 404-299-7766
P. O. Box 1626
Stone Mountain GA 30086
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-08-09
Sent to Provost: 2013-08-14
Sent to Legal:
Completed: 2013-08-27
Requester Name: Kristen Lingle
Document 1: view
Document 2:
Document 3:

 
Stonecrest Pediatric & Adult Medicine
School of Nursing
Michelle Sewell
Phone: 404-297-1818
8225 Mall Parkway Suite 250
Lithonia GA 30038
Agency Email:
Expiration Date: 2016-07-31
Sent to Facility: 2013-08-09
Sent to Provost: 2013-09-06
Sent to Legal:
Completed: 2013-09-18
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Gamma Adult Care, PC
School of Nursing
Stephanie Griswold
Phone: 478-953-2212
109 Osigian Blvd Suite 200
Warner Robins GA 30188
Agency Email: stephanie2gamma@aol.com
Expiration Date: 2016-11-30
Sent to Facility: 2013-12-09
Sent to Provost: 2014-01-08
Sent to Legal:
Completed: 2014-01-14
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Snapfinger Woods Family Practice Group
School of Nursing
Albert Thompson
Phone: 770-981-0600
5071 Snapfinger Woods Drive
Decatur GA 30035
Agency Email: athom@comcast.net
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
St. Vincents Health System
Department of Physical Therapy
Cassie Perry
Phone: (205) 838-3992
810 St. Vincents Drive
Birmingham AL 35205
Agency Email: cassie.perry@ascension.org
Expiration Date: 2020-07-01
Sent to Facility: 2020-02-05
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Recharge
Department of Physical Therapy
Ryan Smith
Phone: 920-728-4714
5136 Dorsey Hall Drive
Ellicott City MD 21042
Agency Email: ryan@rechargexfit.com
Expiration Date: 2020-04-30
Sent to Facility: 2019-11-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
East Cobb Pediatrics & Adolescent Medicine, PC
School of Nursing
Stephanie Patterson
Phone: 770-977-0094
1121 Johnson Ferry Road Suite 220
Marietta GA 30068
Agency Email: spatterson@eastcobbpeds.com
Expiration Date: 2017-04-30
Sent to Facility: 2017-01-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
A Friend s House, Inc.
Department of Nutrition
Susan Heredia
Phone: 678-432-1630 ext 202
111 Henry Parkway
McDonough GA 30253
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-08-26
Sent to Provost: 2013-08-26
Sent to Legal:
Completed: 2013-09-16
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Kids in Motion Therapy
Department of Occupational Therapy
Tammy Queen
Phone: 770-459-6533
113 Commons Way 402
Villa Rica Ga 30180
Agency Email: kidsinmotion2@gmail.com
Expiration Date: 2022-08-31
Sent to Facility: 2019-08-22
Sent to Provost: 2019-08-23
Sent to Legal:
Completed: 2019-09-16
Requester Name: Carolyn Podolski
Document 1: Final Expires August 2022
Document 2:
Document 3:
Comment: Hi Kelli, this is a standard contract. WE are trying to get this done quickly. The said they would return it right away.

 
Covington Womens Health Specialists, LLC
School of Nursing
Denise Cochran
Phone: 770-385-8954
4181 Hospital Drive Suite 100
Covington GA 30014
Agency Email: acochran@cwhs-larrimore.com
Expiration Date: 2022-09-30
Sent to Facility: 2019-09-26
Sent to Provost: 2019-09-30
Sent to Legal:
Completed: 2019-10-03
Requester Name: Lisa Williams
Document 1: Final Expires Sept 2022
Document 2:
Document 3:
Comment: 9/20/19 - please renew

 
Atlanta Obstetrics & Gynecology Associates
School of Nursing
Jennifer Smolen
Phone: 404-355-0320
275 Collier Road Suite 100C
Atlanta GA 30309
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-09-05
Sent to Provost: 2013-09-12
Sent to Legal:
Completed: 2013-09-26
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Comprehensive Women's Healthcare
School of Nursing
Kimberly Carroll
Phone: 404-767-2536
809 Cleveland Avenue, SW Atlanta GA 30315
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-09-05
Sent to Provost: 2013-09-06
Sent to Legal:
Completed: 2013-09-20
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Heras Healthcare
School of Nursing
Maribelle Verdiales
Phone: 770-266-0935
924 West Spring
Monroe GA 30655
Agency Email: info@herashealth.com
Expiration Date: 2019-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: COVERED UNDER MEDLINK GEORGIA, INC MOU.

 
Clearview Regional Medical Center
School of Nursing
James Machado
Phone: 770-267-1792
2151 West Spring Street
Monroe GA 30655
Agency Email:
Expiration Date: 2016-09-30
Sent to Facility: 2013-09-06
Sent to Provost: 2013-10-01
Sent to Legal:
Completed: 2013-10-09
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
Comment: Addendum edits by GSU Leegal being reviewed by Clearview Legal Team 11/17/15. Sent to Legal for Provost signature 12/15. Sent to facility for signature 12/18/15.

 
Randy B. Cronic, MD
School of Nursing
Randy Cronic
Phone: 770-670-4640
3660 Howell Ferry Road
Duluth GA 30096
Agency Email: randy@randycronicmd.com
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-04
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Dahlonega Pediatrics and Adolescent Medicine
BFLCNHP
Maggie Payne
Phone: 706-864-6700
1055 Grove Street, N
Dahlonega GA 30533
Agency Email: Margaret.A.Payne@emory.edu
Expiration Date: 2023-04-30
Sent to Facility: 2020-05-12
Sent to Provost: 2020-05-13
Sent to Legal:
Completed: 2020-06-15
Requester Name: Lisa Williams
Document 1: ExpApril2023 DahlonegaPedsAdol pdf
Document 2:
Document 3:

 
Lawrenceville Pediatrics
School of Nursing
Micah Carver
Phone: 770-962-8025
980 Lawrenceville Highway
Lawrenceville GA 30045
Agency Email: manager@lawrencevillepeds.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-10-21
Sent to Provost: 2016-12-12
Sent to Legal:
Completed: 2017-01-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Salveo Integrative Health
School of Nursing
Dana Stephens-Craig
Phone: 770-241-5235
311 Gwinnett Drive
Lawrenceville GA 30046
Agency Email: dana@salveohealth.org
Expiration Date: 2022-10-31
Sent to Facility: 2019-07-01
Sent to Provost: 2019-07-02
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires October 2022
Document 2:
Document 3:
Comment: Please renew

 
Douglasville Nursing and Rehabilitation Center, LLC
Department of Respiratory Therapy
Vannie Lee
Phone: 770-942-7111
4028 Highway 5 Douglasville GA 30135
Agency Email:
Expiration Date: 2016-08-31
Sent to Facility: 2013-09-18
Sent to Provost: 2013-09-18
Sent to Legal:
Completed: 2013-10-17
Requester Name: Douglas Gardenhire
Document 1:
Document 2:
Document 3:

 
Innovative Womens Healthcare Solutions
School of Nursing
Melinda Miller-Thrasher
Phone: 678-424-1123
3903 South Cobb Drive Suite 105
Smyrna GA 30080
Agency Email: info@iwhcs.com
Expiration Date: 2019-08-31
Sent to Facility: 2019-07-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
PhysioFocus Orthopedic and Sports Medicine, LLC
Department of Physical Therapy
Katie Cusack
Phone: 980-224-7958
9209 Baybrook Lane Charlotte NC 28277
Agency Email:
Expiration Date: 2016-09-30
Sent to Facility: 2013-10-01
Sent to Provost: 2013-10-13
Sent to Legal:
Completed: 2013-10-29
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Northside Pediatrics and Adolescent Medicine, PC
School of Nursing
Vicki Tittle
Phone: 404-705-8990 ext 140
1140 Hammond Drive Suite E 5250
Atlanta GA 30328
Agency Email:
Expiration Date: 2016-09-30
Sent to Facility: 2013-10-02
Sent to Provost: 2013-10-03
Sent to Legal:
Completed: 2013-10-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Cancer Treatment Centers of America, Dept. of Oncology Rehabilitation
Department of Occupational Therapy
Carrie DeSantis
Phone: carrie.desantis@ctca-hope.com
600 Parkway North
Newnan GA 30265
Agency Email: carrie.desantis@ctca-hope.com
Expiration Date: auto renews
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2019-01-22
Requester Name: Carolyn Podolski
Document 1: Automatically Renews
Document 2:
Document 3:

 
Valley View Family Medical Center
School of Nursing
Mike Mulberry
Phone: 706-391-6555
24 Alicia lane Suite 7
Dahlonega GA 30533
Agency Email:
Expiration Date: 2019-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covered under The Longstreet Clinic MOU

 
Atlanta VAMC VISN 7 - Nursing - BSN, MSN, APRN, DNP, PHD
BFLCNHP
Archie Brown
Phone: 404-321-6111 x123784
1670 Clairmont Road Mail Stop (141)
Decatur GA 30033
Agency Email: Archie.Brown@va.gov
Expiration Date: 2030-08-17
Sent to Facility: 2020-05-18
Sent to Provost: 2020-03-17
Sent to Legal:
Completed: 2020-08-17
Requester Name: Lisa Williams
Document 1: ExpAug2030 AtlantaVAMedCenter Nursing
Document 2:
Document 3:
Comment: Affiliations – Archie Brown - Archie.Brown@va.gov Students and faculty boarding – Michelle Cordy - Michelle.Cordy@va.gov Clinical Placements – Choreen Powell - Choreen.Powell2@va.gov Leadership oversight – Theresa Goodman - Theresa.Goodman@va.gov & Emeka Onuorah - Emeka.Onuorah@va.gov

 
Ellis Center
Department of Occupational Therapy
Alison Caputo
Phone: 404-276-1170
189 Sams Street Suite A-1
Decatur Ga 30030
Agency Email: acaputo@ellisschoolatlanta.org
Expiration Date: 2023-04-30
Sent to Facility: 2020-02-25
Sent to Provost: 2020-02-26
Sent to Legal:
Completed: 2020-03-06
Requester Name: Carolyn Podolski
Document 1: exp apr 2023 ...6132234 pdf
Document 2:
Document 3:
Comment: Please update the name to Ellis Center. Thanks! -Letitia Carelock Include J. Esha McTizic in final copy of agreement.

 
GKM Healthcare Solutions, LLC
School of Nursing
Jeff Johnson
Phone: 404-856-0505
1150 Grimes Bridge Rd Suite 400
Roswell GA 30075
Agency Email: gkmhealthcaresolutions@gmail.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-08-04
Sent to Provost: 2016-12-06
Sent to Legal:
Completed: 2016-12-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Maternal Gynerations, PC
BFLCNHP
Nikki Tindol
Phone: 770-513-4000
600 Professional Drive Suite 200
Lawrenceville GA 30046
Agency Email: ntindol@awhg.org
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-09
Sent to Provost: 2016-11-10
Sent to Legal:
Completed: 2016-12-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:

 
OrthoAtlanta
Department of Physical Therapy
Bryan Russell
Phone: 678-684-2220
105 Collier Road Suite 2000
Atlanta GA 30309
Agency Email: brussell@orthoatlanta.com
Expiration Date: 2023-12-31
Sent to Facility: 2019-05-29
Sent to Provost: 2019-06-10
Sent to Legal:
Completed: 2019-06-12
Requester Name: Carla Huggins
Document 1: Final Expires December 2023
Document 2:
Document 3:
Comment: 5/28/19 brussell@orthoatlanta.com bounced, emailed masiki 5/29/19 called Orthoatlanta, sent email to gharrison@intrahealthgroup.com per lady who answered the phone.

 
Augusta Hospital, LLC
School of Nursing
Leigh Hamilton
Phone: 706-481-7678
2260 Wrightsboro Road Augusta GA 30904-7426
Agency Email:
Expiration Date: 2018-09-30
Sent to Facility: 2013-07-03
Sent to Provost: 2013-11-04
Sent to Legal:
Completed: 2013-11-07
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: Trinity Hospital of Augusta

 
American Society for Nutrition
Department of Nutrition
Sarah Ohlhorst
Phone: 301-634-7281
9650 Rockville Pike Bethesda MD 20814
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-07
Sent to Provost: 2013-11-22
Sent to Legal:
Completed: 2013-11-26
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Global Growers Network
Department of Nutrition
Robin Chanin
Phone: 404-590-7249
P. O. Box 276 Avondale Estates GA 30002
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-14
Sent to Provost: 2013-12-05
Sent to Legal:
Completed: 2013-12-17
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: Non-Clinical MOU

 
Alphacare Medical Center
School of Nursing
Mariam Latif
Phone: 770-752-8440
1865 Lockeway Drive Suite 603
Alpharetta GA 30004
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-15
Sent to Provost: 2013-12-05
Sent to Legal:
Completed: 2013-12-17
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Park Avenue Family Practice
School of Nursing
James Sayegh
Phone: 914-965-4300
102 Park Avenue
Yonkers NY 10703
Agency Email:
Expiration Date: 2016-11-30
Sent to Facility: 2013-11-15
Sent to Provost: 2013-12-03
Sent to Legal:
Completed: 2013-12-06
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Wm. Jennings Bryan Dorn Department of Veteran Affairs Medical Center (544/141)
Department of Physical Therapy
Tom Wiseman
Phone: 803-695-7934
6439 Garners Ferry Road Columbia SC 29209
Agency Email: thomas.wiseman@va.gov
Expiration Date:
Sent to Facility: 2013-11-18
Sent to Provost: 2013-12-20
Sent to Legal:
Completed: 2014-01-14
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: No Expiration Date. Can be terminated in writing by either party in writing 6 months in advance of the next training experience.

 
Georgia Tech Athletic Association
Department of Nutrition
Leah Thomas
Phone: 404-759-0626
150 Bobby Dodd Way
Atlanta GA 30332
Agency Email: Lthomas@gtaa.gatech.edu
Expiration Date: 2019-12-31
Sent to Facility: 2020-02-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: This MOU has expired :( If we have to start all over, I apologize!

 
Rebound Physical Therapy
Department of Physical Therapy
Lauren Weaver
Phone: 678-445-9799
980 Woodstock Pkwy Suite 200
Woodstock GA 30189
Agency Email: lauren.weaverdpt@gmail.com
Expiration Date: 2023-12-31
Sent to Facility: 2019-06-06
Sent to Provost: 2019-06-10
Sent to Legal:
Completed: 2019-06-12
Requester Name: Carla Huggins
Document 1: Final Expires December 2023
Document 2:
Document 3:
Comment: Dr. Joe Kapati, DPT, Owner/Director

 
Tallahassee Physical Therapy
Department of Physical Therapy
Boyd Yost
Phone: 850-877-8177
132 Salem Court Tallahassee FL 32301
Agency Email:
Expiration Date: 2016-12-31
Sent to Facility: 2013-12-10
Sent to Provost: 2014-01-07
Sent to Legal:
Completed: 2014-01-14
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
Generation in Focus
Department of Nutrition
Tiffany Ray
Phone: 678-653-8850
P. O. Box 1472 Austell GA 30168
Agency Email: tiffany@generationsinfocus.com
Expiration Date:
Sent to Facility: 2013-12-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Family Practice Center, PC
BFLCNHP
Brittany Moore
Phone: 404-256-1727
993 Johnson Ferry Rd Suite 210
Atlanta GA 30342
Agency Email: brittany@familypracticecenterpc.com
Expiration Date: 2025-3-31
Sent to Facility: 2022-04-06
Sent to Provost: 2018-09-13
Sent to Legal:
Completed: 2022-04-13
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 4/6/2022 - sent renewal. LYW

 
North Health District
School of Nursing
David Westfall
Phone: 770-535-5958
1280 Athens Street
Gainesville GA 30507
Agency Email: ahhanes@dhr.state.ga.us
Expiration Date: 2016-12-31
Sent to Facility: 2013-12-17
Sent to Provost: 2014-01-06
Sent to Legal:
Completed: 2014-01-14
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Valdosta Orthopedic Associates
School of Nursing
Ursuline Sookoo
Phone: 229-247-2290
3527 North Valdosta Road
Valdosta GA 31602
Agency Email: ursuline@voa-online.com
Expiration Date: 2016-12-31
Sent to Facility: 2013-12-20
Sent to Provost: 2014-01-07
Sent to Legal:
Completed: 2014-01-14
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
The University of Georgia Athletic Association
Department of Nutrition
Jana Heitmeyer
Phone: 706-542-7857
1 Selig Circle
Athens GA 30602
Agency Email: janah@sports.uga.edu
Expiration Date: 2024-08-31
Sent to Facility: 2018-06-22
Sent to Provost: 2018-07-12
Sent to Legal:
Completed: 2021-08-05
Requester Name: Jessica Todd
Document 1: The University of Georgia Athletic Association
Document 2:
Document 3:
Comment: Non clinical agreement renewal. Please CC Maria Breen mbreen@sports.uga.edu

 
Atlanta Functional Medicine
School of Nursing
Elizabeth Board
Phone: 770-504-6197
5755 North Point Suite 74
Alpharetta GA 30022
Agency Email: atlantafunctionalmedicine@gmail.com
Expiration Date: 2016-12-31
Sent to Facility: 2014-01-10
Sent to Provost: 2014-01-14
Sent to Legal:
Completed: 2014-02-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
One Love Learning Foundation
Department of Nutrition
Brenda Isaac
Phone: 678-9077-9401
263 Walker Street Atlanta GA 30313
Agency Email: bisaac000@gmail.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-14
Sent to Provost: 2014-01-27
Sent to Legal:
Completed: 2014-01-27
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
St. Louis Childrens Hospital
Department of Physical Therapy
Pamela Carpenter
Phone: 314-454-6154
1 Childrens Place
St. Loius MO 63110
Agency Email: pamelaap@bjc.org
Expiration Date:
Sent to Facility: 2014-01-24
Sent to Provost: 2014-09-19
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sent to Legal for Provost signature 9/15.Sent to agency for sig 9/26

 
A Womans Space
School of Nursing
Claudia Crenshaw
Phone: 404-403-2669
315 West Ponce de Leon Avenue Suite 540
Decatur GA 30030
Agency Email: claudiacrenshaw@bellsouth.net
Expiration Date: 2017-10-31
Sent to Facility: 2014-09-29
Sent to Provost: 2014-10-19
Sent to Legal:
Completed: 2014-11-03
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Real Health Medical
School of Nursing
Rhett L. Bergeron
Phone: 678-990-5401
555 Sun Valley Drive Suite D4
Roswell GA 30076
Agency Email: biologicalmd@aol.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-17
Sent to Provost: 2014-01-20
Sent to Legal:
Completed: 2014-02-04
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
TMB Medical
School of Nursing
Casey Howard
Phone: 706-548-9655
1181 Langford Drive Bldg 200, Suite 105
Watkinsville GA 30677
Agency Email: tmbmedical@gmail.com
Expiration Date: 2024-03-31
Sent to Facility: 2014-01-17
Sent to Provost: 2014-11-05
Sent to Legal:
Completed: 2021-06-08
Requester Name: Lisa Williams
Document 1: view
Document 2: TMB Medical_exp_03-31-2021
Document 3:

 
Sun Pediatrics
BFLCNHP
Charlotte Grulke
Phone: 678-501-5601
2520 Windy Hill Road Suite 104
Marietta GA 30067
Agency Email: cfgrulke@bellsouth.net
Expiration Date: 2023-07-31
Sent to Facility: 2014-01-22
Sent to Provost: 2020-07-29
Sent to Legal:
Completed: 2020-08-10
Requester Name: Lisa Williams
Document 1: ExpJuly2023 SunPediatrics July2020
Document 2:
Document 3:

 
Womens Healthcare Associates
School of Nursing
Cheryl Locke
Phone: 706-369-0019
355 Hawthorne Lane
Athens GA 30606
Agency Email: clocke@womenshealthcareassociates.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-01-22
Sent to Provost: 2014-01-23
Sent to Legal:
Completed: 2014-02-04
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Spelman College
BFLCNHP
Dana Lloyd
Phone: 404-270-5250
McVicar Hall 350 Spelman Lane
Atlanta GA 30314
Agency Email: DLloyd@spelman.edu
Expiration Date: 2020-02-29
Sent to Facility: 2020-04-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Mpower Performance Institute
Department of Physical Therapy
Micah Washington
Phone: 615-324-1600, ext. 262
2001 Woodmont Boulevard
Nashville TN 37215
Agency Email: mwashington@eliteorthopaedic.com
Expiration Date: 2020-09-30
Sent to Facility: 2020-05-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: exp sep2020 mpower sep2020_001
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu on communication.

 
Incremedical Management, Inc.
Department of Physical Therapy
Amy Derosa
Phone: 800-870-4540
8259 Wicker Avenue
St. John IN 46373
Agency Email: Aderosa@incremedical.com
Expiration Date: 2024-08-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-31
Sent to Legal:
Completed: 2021-08-04
Requester Name: Carla Huggins
Document 1: Exp Dec 2022 doc03522320191101130958
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu>

 
Hope Health Clinic of Spalding County, Inc.
School of Nursing
Ann Cherrette
Phone: 678-688-8711
409 West Solomon Street Griffin GA 30223
Agency Email: acherrette@hopehealthclinic.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-02-07
Sent to Provost: 2014-02-07
Sent to Legal:
Completed: 2014-03-12
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:

 
Dr. George C. Pursley, MD
School of Nursing
Melissa Owens
Phone: 706-869-9222
1219 West Wheeler Pkwy Suite A
Augusta GA 30909
Agency Email: mgowens88@hotmail.com
Expiration Date: 2017-01-31
Sent to Facility: 2014-02-07
Sent to Provost: 2014-02-21
Sent to Legal:
Completed: 2014-03-06
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Medical Care of LaGrange, LLC
School of Nursing
Debbie Morris
Phone: 706-882-8971
300 Medical Drive Suite 701
LaGrange GA 30240
Agency Email: dmorrismcl@gmail.com
Expiration Date: 2017-02-28
Sent to Facility: 2014-02-15
Sent to Provost: 2014-02-26
Sent to Legal:
Completed: 2014-03-06
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Souza Family Health & Urgent Care Center, LLC
School of Nursing
Dawn Drew
Phone: 478-304-1268
P.O. Box 16100
Dublin GA 31040
Agency Email: manager@hillcrestuc.com
Expiration Date: 2017-02-28
Sent to Facility: 2014-02-15
Sent to Provost: 2014-04-11
Sent to Legal:
Completed: 2014-04-21
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Med South Associates, PC
School of Nursing
Richard Wright
Phone: 770-996-9400
6572 River Park Drive Suite 102
Riverdale GA 30274
Agency Email: medsouthassociates@yahoo.com
Expiration Date: 2019-03-31
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: additioanl address: frontdesk121@yahoo.com

 
Alpharetta Internal Medicine
School of Nursing
Kaya Caldwell
Phone: 770-475-2377
1380 Upper Hembree Road
Roswell GA 30076
Agency Email: kayacaldwell@gmail.com
Expiration Date: 2017-02-08
Sent to Facility: 2014-02-15
Sent to Provost: 2014-02-24
Sent to Legal:
Completed: 2014-03-14
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Sugarloaf Pediatrics
School of Nursing
Susamma Mathew
Phone: 678-377-1113
3525 Sugarloaf Parkway
Lawrenceville GA 30044
Agency Email: cmmathew1@gmail.com
Expiration Date: 2019-02-28
Sent to Facility: 2019-01-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 1/11/19 - Please renew 4/12/19 - the site does not wish to renew. LYW

 
Miller Family Practice
School of Nursing
Conrad Miller
Phone: 478-745-7878
1818 Forsyth Street
Macon GA 31201
Agency Email: mfpmacon@gmail.com
Expiration Date: 2017-02-28
Sent to Facility: 2014-02-26
Sent to Provost: 2015-01-06
Sent to Legal:
Completed: 2015-01-16
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Fully executed MOU mailed to Agency 1/20.

 
Atlanta Childrens Shelter
Department of Nutrition
Mellony Gaston
Phone: 404-892-3713
607 Peachtree Street, NE
Atlanta GA 30308
Agency Email: mgaston@acsatl.org
Expiration Date: 2020-02-28
Sent to Facility: 2017-01-10
Sent to Provost: 2017-01-11
Sent to Legal:
Completed: 2017-01-18
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Atlanta Center for Eating Disorders
Department of Nutrition
Julie Orr
Phone: 770-458-8753 ext 217
4536 Barclay Drive Suite A
Dunwoody GA 30338
Agency Email: OrrJE0123@gmail.com
Expiration Date: 2017-02-28
Sent to Facility: 2014-02-27
Sent to Provost: 2014-03-03
Sent to Legal:
Completed: 2014-03-12
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Sysco Atlanta, LLC
Department of Nutrition
Mary Groover
Phone: 404-592-2601
2225 Riverdale Road P. O. Box 490379
College Park GA 30349
Agency Email: groover.mary@atl.sysco.com
Expiration Date: 2017-02-28
Sent to Facility: 2014-01-09
Sent to Provost: 2014-04-01
Sent to Legal:
Completed: 2014-04-10
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Good Samaritan Health Center
Department of Nutrition
Jeryln Jones
Phone: 678-553-4935
1015 Donald Lee Hollowell Pkwy
Atlanta GA 30318-6653
Agency Email: jerlyn@goodsamatlanta.org
Expiration Date: 2023-11-30
Sent to Facility: 2017-01-17
Sent to Provost: 2017-01-25
Sent to Legal:
Completed: 2021-02-05
Requester Name: Jessica Todd
Document 1: Good Samaritan Health Center_02-05-2021
Document 2:
Document 3:

 
Jewish Family and Career Services of Atlanta
Department of Nutrition
Faye Dresner
Phone: 7706779431
4549 Chamblee Dunwoody Rd
Atlanta ga 30338
Agency Email: jweissman@jfcs-atlanta.org
Expiration Date:
Sent to Facility: 2018-01-18
Sent to Provost: 2018-01-19
Sent to Legal:
Completed: 2018-01-24
Requester Name: Jessica todd
Document 1: Jewish Family and Career Services of Atlanta
Document 2: Jewish Family and Career Center of
Document 3:
Comment: Non clinical agreement; please send to Faye with a CC to Jennifer

 
Rockdale Family Practice, PC
BFLCNHP
Laurie Bazzani
Phone: 770-929-0813
2020 Honey Creek Parkway, SE
Conyers GA 30013
Agency Email: lbazzani@rockdalefamilypractice.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-08
Sent to Provost: 2017-11-08
Sent to Legal:
Completed: 2017-11-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Family Center for Health
School of Nursing
Jose Baez
Phone: 770-814-8790
3750 Venture Drive Suite D-11
Duluth GA 30096
Agency Email: familycenterforhealth@gmail.com
Expiration Date: 2018-02-28
Sent to Facility: 2015-03-06
Sent to Provost: 2015-03-06
Sent to Legal:
Completed: 2015-03-26
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: renewal sent 2/26/18

 
Childrens Physician Group - Orthopaedics (CHOA)
School of Nursing
Carrie Cowart
Phone: 678-541-6407
5445 Meridian Mark Road Suite 250
Atlanta GA 30342
Agency Email: carrie.cowart@choa.org
Expiration Date: 2020-02-29
Sent to Facility: 2020-03-26
Sent to Provost:
Sent to Legal:
Completed: 2020-07-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: https://www.choa.org/medical-services/childrens-physician- group/orthopaedics This facility is covered under the blanket CHOA contract.

 
University of Florida Pediatric Pulmonary
Department of Nutrition
Ellen Ellen Bowser
Phone: 352-273-8380
P. O. Box 100296 Gainesville GA 32610-0296
Agency Email: bowseek@peds.ufl.edu
Expiration Date: 2017-02-28
Sent to Facility: 2014-03-10
Sent to Provost: 2014-04-10
Sent to Legal:
Completed: 2014-05-08
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:

 
Trinity Clinic
School of Nursing
Swapna Reddy
Phone: 678-935-0150
5860 Jimmy Carter Boulevard Suite 125
Norcross GA 30071
Agency Email: trinityfamilyclinic16@gmail.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-29
Sent to Provost: 2018-01-29
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Will
Document 1:
Document 2:
Document 3:
Comment: complete

 
Advantage Behavioral Health Systems
School of Nursing
Kadesha Clark-Evans
Phone: 706-369-5745
195 Miles Street
Athens GA 30601
Agency Email: rcereneche@advantagebhs.org
Expiration Date: 2017-03-31
Sent to Facility: 2014-03-17
Sent to Provost: 2014-05-08
Sent to Legal:
Completed: 2014-05-28
Requester Name: JoAnn Bacon
Document 1: view
Document 2:
Document 3:

 
Flint River Physical Therapy
Department of Physical Therapy
Michael Shriver
Phone: 229-883-4009
130 E Broad Street
Camilla GA 37730
Agency Email: flintriverpt@camillaga.net
Expiration Date: 2023-03-31
Sent to Facility: 2019-11-14
Sent to Provost: 2019-11-21
Sent to Legal:
Completed: 2019-12-16
Requester Name: Carla Huggins
Document 1: Final Expires March 2023 ...flint riverpdf
Document 2:
Document 3:

 
Buford Family Practice
School of Nursing
Alexander Osowa
Phone: 678-541-0588
2805 Hamilton Mill Road
Buford GA 30519
Agency Email: frontoffice@bufordfamilypractice.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-02-07
Sent to Provost: 2019-02-14
Sent to Legal:
Completed: 2019-02-19
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment:

 
Perimeter Primary Care
School of Nursing
Stan Brown
Phone: 770-391-0552
5885 Glenridge Road
Sandy Springs GA 30328
Agency Email: DrBrown@Ppcare.com
Expiration Date: 2017-03-31
Sent to Facility: 2014-03-27
Sent to Provost: 2014-03-31
Sent to Legal:
Completed: 2014-04-10
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Hughston Clinic
Department of Physical Therapy
Taylor Childs
Phone: 706-494-3128
6298 Veterans Parkway Ste. 9
Columbus GA 31909
Agency Email: dgoowin@hughston.com
Expiration Date:
Sent to Facility: 2020-04-14
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Contract includes the following site locations: Albany (117 Oakland Parkway, Albany, GA 31763) Auburn (6262 Veterans Parkway, Auburn, AL 36832) Columbus (6298 Veterans Parkway, Columbus, GA 31909) Dothan (512 North Shady Lane, Dothan, AL 36303) Dublin (100 Medical Drive Suite 200, Dublin, GA 31021) Fleming Island (4689 Hwy 17 Suit 11, Fleming Island, FL, 32003) LaGrange (107 Calumet Center Road, LaGrange, GA 30240) Macon (100 North Macon St, Macon, GA 31210) Thomaston (522 North Center Street, Thomaston, GA 30286) Valdosta (4340 Kings Way, Valdosta, GA 31602)

 
Harper & Associates Family Medicine, PC
School of Nursing
Tara Bowens
Phone: 678-418-2120
1000 Hillandale Drive Suite 100
Lithonia GA 30058
Agency Email: tara@kharpermd.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-13
Sent to Provost: 2017-12-15
Sent to Legal:
Completed: 2017-12-18
Requester Name: Lisa Williams
Document 1: Termination of Agreement Letter, Closing Practice
Document 2:
Document 3:
Comment: 1/21/2021 - Northside Hospital affiliated practice. Covered under Northside contract. LYW

 
Cobb Pediatric Associates
School of Nursing
Maggie Peters
Phone: 770-941-7709
1664 Mulky Road
Austell GA 30106
Agency Email: m.peters@cobbpedassoc.com
Expiration Date: 2017-03-31
Sent to Facility: 2014-04-09
Sent to Provost: 2014-04-14
Sent to Legal:
Completed: 2014-04-25
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Bibb County Public Schools
Department of Nutrition
Cleta Long
Phone: 478-779-2612
2011 Riverside Drive Macon GA 31204
Agency Email: clong@bib.k12.ga.us
Expiration Date: 2017-03-31
Sent to Facility: 2014-04-14
Sent to Provost: 2014-04-14
Sent to Legal:
Completed: 2014-04-25
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: Non-Clinical

 
Childrens Healthcare of Atlanta, Inc.
Brydine F Lewis School of Nursing and Health Professions
Jennifer Bay
Phone: 404-785-7640
1600 Tullie Circle
Atlanta GA 30329
Agency Email: jennifer.bay@choa.org
Expiration Date: 2023-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-07-30
Requester Name: Caroline Lombard
Document 1: ExpJuly2023 CHOA BOR July2023 pdf
Document 2: ExpJuly2023 CHOA GSU July2023
Document 3:
Comment: Processed by the BOR.

 
Zoe Pediatrics
School of Nursing
Waine Kong
Phone: 706-938-0990
210 Hannahs Mill Road
Thomaston GA 30286
Agency Email: bwaine@zoepeds.com
Expiration Date:
Sent to Facility: 2014-04-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: Thomaston, GA, Columbus, GA & Barnesville, GA

 
Camp Twinlakes
Department of Nutrition
Dan Matthews
Phone: 706-557-9070 Ext. 403
1391 Keencheefoonee Road
Rutledge GA 30663
Agency Email: dan@camptwinlakes.org
Expiration Date: 2020-04-30
Sent to Facility: 2017-01-31
Sent to Provost: 2017-04-06
Sent to Legal:
Completed: 2017-04-14
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
West Central Health District
School of Nursing
Asante Hilts
Phone: 706-321-6120
PO Box 2299
Columbus GA 31902-6120
Agency Email: asante.hilts@dph.ga.gov
Expiration Date: 2017-04-30
Sent to Facility: 2018-11-27
Sent to Provost: 2018-11-13
Sent to Legal:
Completed: 2018-11-29
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Contract renews annually automatically.

 
Premier Medical Associates
BFLCNHP
Misty McConnell
Phone: 770-888-6697
407 East Maple Street
Cumming GA 30040
Agency Email: Misty.McConnell@pma.healthcare
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-22
Sent to Provost: 2017-12-05
Sent to Legal:
Completed: 2017-12-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Exclusive Womens Healthcare
School of Nursing
Jaliwa Hall
Phone: 678-817-6991
155 Carnegie Place Suite 203
Fayetteville GA 30214
Agency Email: drsonyika@bellsouth.net
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-09
Sent to Provost: 2018-01-12
Sent to Legal:
Completed: 2018-01-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
University Health Services, Inc.
School of Nursing
Chris Westbrook
Phone: 706-774-5785
1350 Walton Way
Augusta GA 30901
Agency Email: Barnett/Contract/UHI@UHSMAIL
Expiration Date: 2021-01-28
Sent to Facility: 2017-10-29
Sent to Provost: 2017-11-29
Sent to Legal:
Completed: 2018-01-29
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Van Meter Pediatric Endocrinology
School of Nursing
Vanessa Lum
Phone: 678-961-2100
1800 Howell Mill Road, NW Suite 475
Atlanta GA 30318
Agency Email: vlum@pediatricendo.com
Expiration Date: 2023-04-30
Sent to Facility: 2020-03-10
Sent to Provost: 2020-04-22
Sent to Legal:
Completed: 2020-06-24
Requester Name: Lisa Williams
Document 1: ExpApr2023 VanMeterPedsEndo_Apr2020 - signed
Document 2:
Document 3:
Comment: 3/2/20 - please renew. LYW

 
Jacobs Ladder School and Therapy Center
School of Nursing
Amber McNeely
Phone: 770-998-1017
407 Hardscrabble Road
Roswell GA 30075
Agency Email: frontoffice@jacobsladderschool.net
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-02
Sent to Provost: 2014-05-21
Sent to Legal:
Completed: 2014-05-28
Requester Name: JoAnn Bacon
Document 1: view
Document 2:
Document 3:

 
Atlanta Pelvic & Orthopedic Rehabilitation Center
Department of Physical Therapy
Olabisi Brown
Phone: 404-935-9000
2591 Piedmont Road Suite 104
Atlanta GA 30324
Agency Email: O_brown@atlrehabcenter.com
Expiration Date: 2023-05-31
Sent to Facility: 2019-11-14
Sent to Provost: 2020-01-07
Sent to Legal:
Completed: 2020-01-14
Requester Name: Carla Huggins
Document 1: exp may 2023 ...113209.pdf
Document 2:
Document 3:

 
Kennesaw State University
Department of Nutrition
Sherry Grable
Phone: 470-578-3517
290 Kennesaw State University Road Room 1200, MD 0301
Kennesaw GA 30144-5591
Agency Email: sgrable@kennesaw.edu
Expiration Date: 2020-05-31
Sent to Facility: 2020-08-25
Sent to Provost: 2020-06-08
Sent to Legal: 2020-06-03
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: 7/14/2020 inquired with Kisha 8/5/2020 inquired with Kisha 8/25/20 provost signed, to facility for final signatures

 
Clarke County School District
Department of Nutrition
Paula Farmer
Phone: 706-354-1138 ext. 77351
145 Paradise Blvd.
Athens GA 30607
Agency Email: farmerp@clarke.K12.ga.us
Expiration Date: 2020-05-31
Sent to Facility: 2017-03-09
Sent to Provost: 2017-04-13
Sent to Legal:
Completed: 2017-04-20
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Stella Medical Center
School of Nursing
Caroline Anaele
Phone: 678-594-3881
2121 Fairburn Road
Douglasville GA 30135
Agency Email: canaele1@gmail.com
Expiration Date: 2020-05-31
Sent to Facility: 2017-03-09
Sent to Provost: 2017-05-2017
Sent to Legal:
Completed: 2017-05-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Gwinnett County Public School--OT
Department of Occupational Therapy
Stefanie Case
Phone: 678-301 6807
437 Old Peachtree Rd.
Suwanee GA 30024
Agency Email: stefanie_case@gwinnett.k12.ga.us
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-28
Sent to Provost: 2018-02-26
Sent to Legal:
Completed: 2018-03-15
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: complete

 
Georgia Perimeter College
School of Nursing
Suzanne Wetter
Phone: 678-891-4105
555 North Indian Creek Dr. H Bldg - Suite 210
Clarkston GA 30021
Agency Email: suzannewetter@gpc.edu
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-06
Sent to Provost: 2014-06-05
Sent to Legal:
Completed: 2014-06-13
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Playmatters Inc.
Department of Occupational Therapy
Carol Taylor
Phone: 404-474-0506
4641 Roswell Rd.
Atlanta Ga 30342
Agency Email: assistant@playmatterstherapy.com
Expiration Date: 2024-01-31
Sent to Facility: 2020-08-04
Sent to Provost:
Sent to Legal:
Completed: 2021-02-05
Requester Name: Shana Finks
Document 1: Playmatters Inc_02-05-2021
Document 2:
Document 3:

 
Northeast Georgia Physicians Group
BFLCNHP
Samantha Nanartowicz
Phone: 770-219-2091
675 White Sulphur Road
Gainesville GA 30501
Agency Email: samantha.nanartowicz@nghs.com
Expiration Date: 2024-01-14
Sent to Facility: 2020-04-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Northeast Georgia Physicians Group_02_17-21
Document 2:
Document 3:
Comment: Includes Toccoa Clinical Medical Associates now known as NGPG Toccoa Clinic.

 
MedSide Healthcare
Department of Physical Therapy
Siri Yellamraju
Phone: 404-633-7433
1120 Hope Road
Sandy Springs GA 30350
Agency Email: mary@medside.com
Expiration Date: 2023-05-31
Sent to Facility: 2020-02-25
Sent to Provost: 2020-02-27
Sent to Legal: 2020-02-04
Completed: 2020-03-06
Requester Name: Carla Huggins
Document 1: exp may 2023 ...MedsideHealthcare Nov2019
Document 2:
Document 3:
Comment: Please send MOU directly to Mary Mann at mary@medside.com. 2/3/2020 Facility had changes to our document, sent to C. Lombard via email 2/24/2020 (per C. Lombard) Hey Kelli, I talked to their counsel and we are good to go. But she needs a Word version of the PDF you sent her. Please email Konny Light at konny@medside.com. 2/25/20 emailed word version to Konny Light

 
PACT, ATL. LLC
BFLCNHP
Todd Antin
Phone: 404-292-3810
465 Winn Way Suite 221
Decatur GA 30030
Agency Email: drantin@pactatl.com
Expiration Date: 2023-05-31
Sent to Facility: 2020-04-29
Sent to Provost: 2020-04-29
Sent to Legal:
Completed: 2020-05-04
Requester Name: Lisa Williams
Document 1: ExpMay2023 PACT_Apr2020 - signed
Document 2:
Document 3:

 
West Georgia Medical Center, Inc. d/b/a/ West Georgia Health
School of Nursing
Jerry Fulks
Phone: 706-882-1411
1514 Vernon Road
LaGrange GA 30240
Agency Email: mortonv@wghealth.org
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-21
Sent to Provost: 2014-08-27
Sent to Legal:
Completed: 2014-09-12
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: letter to terminate from facility

 
The Drake House
School of Nursing
Christy Merritt
Phone: 770-587-4712 ext. 303
10500 Clara Drive
Roswell GA 30075
Agency Email: cmerritt@thedrakehouse
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-27
Sent to Provost: 2014-05-27
Sent to Legal:
Completed: 2014-06-05
Requester Name: JoAnn Bacon
Document 1: view
Document 2:
Document 3:

 
Kershaw Health
School of Nursing
Amy Kinard
Phone: 803-432-4311
1315 Roberts Street
Camden SC 29020
Agency Email: kinard@kershawhealth.org
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-27
Sent to Provost: 2014-08-06
Sent to Legal:
Completed: 2014-08-29
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Park Springs
Department of Nutrition
Margot Witteveen
Phone: 678-684-3095
600 Spring House Circle Stone Mountain GA 30087
Agency Email: margotwitteveen@parksprings.com
Expiration Date: 2017-05-31
Sent to Facility: 2014-05-29
Sent to Provost: 2014-06-10
Sent to Legal:
Completed: 2014-06-19
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Sent to Legal for Provost sig 6/17/14

 
North Central Health District
School of Nursing
David Harvey
Phone: 478-751-6303
201 2nd Street Suite 1100
Macon GA 31201-6328
Agency Email: amber.erickson@dph.ga.gov
Expiration Date: 2017-05-31
Sent to Facility: 2014-06-03
Sent to Provost: 2014-07-10
Sent to Legal:
Completed: 2014-08-01
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Corporate Health Partners
Department of Nutrition
Ingrid Hill
Phone: 4047257101
2105 Barrett Park Drive Suite 106
Kennesaw GA 30144
Agency Email: ingrid.hill@chp-inc.com
Expiration Date: 2020-05-31
Sent to Facility: 2017-03-10
Sent to Provost: 2017-04-03
Sent to Legal:
Completed: 2017-04-20
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Custom Physical Therapy
Department of Physical Therapy
Linda Paolone
Phone: 805-446-3141
325 Rolling Oaks Drive Suite 210
Thousand Oaks CA 91361
Agency Email: paolone@customphysicaltherapy.com
Expiration Date: 2017-05-31
Sent to Facility: 2017-02-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
Atlanta Falcons:Sports Medicine and Performance
Department of Physical Therapy
Marty Lauzon
Phone: 770-965-2751
4400 Falcon Parkway
Flowery Branch GA 30542
Agency Email: mlauzon@falcons.nfl.com
Expiration Date: 2017-11-30
Sent to Facility: 2014-06-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:

 
TIRR Memorial Hermann Health System - PT and OT
Department of Physical Therapy
Anando Chowdhury
Phone: 713-704-2100
6411 Fannin Ground Floor, Jones Pavilion
Houston TX 77030
Agency Email: Anando.Chowdhury@memorialhermann.org
Expiration Date: 2022-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: exp Jul 2022 0460 001 pdf
Document 2: MemHermann OT pdf
Document 3:

 
United States Army Medical Department Activity (USA MEDDAC)
School of Nursing
Gennetta Norton
Phone: 912-435-5038
Business Operations Divisions
Fort Stewart GA 31314-5641
Agency Email: gennetta.m.norton.civ@mail.mil
Expiration Date: 2016-12-31
Sent to Facility: 2014-05-19
Sent to Provost: 2014-10-24
Sent to Legal:
Completed: 2014-12-08
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Fresh 'n Fit Cuisine
Department of Nutrition
Elston Collins
Phone: 678-208-0341 ext. 303
6080 Parkway North Drive Suite 200
Cumming GA 30040
Agency Email: elston@freshnfitcuisine.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: Agency Withdrew From Participation.

 
TD Wellness
Department of Nutrition
David Orozco
Phone: 770-853-0851
160 Clairmont Avenue Suite 200
Decatur GA 30030
Agency Email: david.orozco@tdwellness.com
Expiration Date: 2023-07-31
Sent to Facility: 2020-06-03
Sent to Provost: 2020-07-24
Sent to Legal:
Completed: 2020-07-29
Requester Name: Jessica Todd
Document 1: ExpJuly 2023 MOU TD Wellness
Document 2:
Document 3:
Comment: non clinical

 
Pea Pod Nutrition and Lactation Support
Department of Nutrition
Alicia Simpson
Phone: 678-607-6052
235 E. Ponce De Leon Avenue Suite 206
Decatur GA 30030
Agency Email: alicia@peapodnutrition.org
Expiration Date: 2023-07-31
Sent to Facility: 2020-04-29
Sent to Provost: 2020-07-24
Sent to Legal:
Completed: 2020-08-04
Requester Name: Jessica Todd
Document 1: ExpJuly2023 PeaPodNutritionLactation_Apr2020 - signed
Document 2:
Document 3:
Comment: non clinical

 
University of Pittsburgh Medical Center
Department of Physical Therapy
Dina Jones
Phone: 412-647-1235
200 Lotrop Street Physical Therapy Department
Pittsburgh PA 15231
Agency Email:
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Archived record #822

 
Texas Health Physicians Group
School of Nursing
Stephanie Stewart
Phone: 214-916-5607
9229 LBJ Freeway
Dallas TX 75243
Agency Email: StephanieStewart@texashealth.org
Expiration Date: 2017-07-14
Sent to Facility: 2014-07-14
Sent to Provost: 2014-10-01
Sent to Legal:
Completed: 2014-10-07
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
ApolloMD
School of Nursing
Evan Howell
Phone: 404-645-7862
5665 New Northside Drive Suite 200
Atlanta GA 30328
Agency Email: ehowell@apollomd.com
Expiration Date: 2017-09-30
Sent to Facility: 2014-10-07
Sent to Provost: 2014-10-07
Sent to Legal:
Completed: 2014-10-23
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Apollo MD staffs the Emergency Departments for WellStar Hospitals so this site will cover multiple locations. Thank you,Sheryl

 
Feminist Womens Health Center
School of Nursing
Kimberly Matchett
Phone: 404-728-7900
1924 Cliff Valley Way, NE
Atlanta GA 30329
Agency Email: Kimberlym@feministcenter.org
Expiration Date: 2017-07-31
Sent to Facility: 2014-07-14
Sent to Provost: 2014-07-30
Sent to Legal:
Completed: 2014-08-15
Requester Name: JoAnn Bacon
Document 1: view
Document 2:
Document 3:

 
The Medical Group of Central Georgia
School of Nursing
Carlos Buchhammer
Phone: 478-411-2288
2054 Watson Blvd
warner robins GA 31093
Agency Email: buchhammercarlos@gmail.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-07
Sent to Provost: 2017-09-13
Sent to Legal:
Completed: 2017-09-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete. sent to all parties

 
Fieldale Farms Family Health Center
School of Nursing
Johnathan Cueto
Phone: 770-532-5685
584 Lanier Park Drive
Gainesville GA 30501
Agency Email: johnathancueto@gmail.com
Expiration Date:
Sent to Facility: 2014-07-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: MOU-Emailed

 
Care Psychiatry
School of Nursing
Giri Vayalapalli
Phone: 404-994-5000
950 Scales Road #302
Suwanee GA 30024
Agency Email: care@carepsych.com
Expiration Date: 2023-11-30
Sent to Facility: 2020-09-08
Sent to Provost:
Sent to Legal:
Completed: 2020-11-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: complete

 
Womans Care Center
School of Nursing
Sharon Hopkins
Phone: 478-453-8100
1001 Fernwood Drive
Milledgeville GA 31061
Agency Email: wcc669@hotmail.com
Expiration Date: 2017-07-31
Sent to Facility: 2014-07-24
Sent to Provost: 2014-07-29
Sent to Legal:
Completed: 2014-08-15
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: MOU E-mailed;sent to Legal for Provost sig 8/6/14

 
Mercy Heart Inc.
School of Nursing
Edwin Conway
Phone: 770-354-1823
2340 Magnolia Dr., NW
Conyers GA 30012-3120
Agency Email: conwaypat@bellsouth.net
Expiration Date: 2017-07-31
Sent to Facility: 2014-07-29
Sent to Provost: 2014-08-01
Sent to Legal:
Completed: 2014-08-14
Requester Name: Kenya Kirkendoll
Document 1: view
Document 2:
Document 3:

 
Georgia Department of Corrections
School of Nursing
Erin Warnock
Phone: 478-445-5973
P. O. Box 278 2271 Vinson Hwy
Hardwick GA 31034
Agency Email: PCD-HSCRO@dcor.state.ga.us
Expiration Date: 2021-06-30
Sent to Facility: 2020-08-10
Sent to Provost: 2020-07-06
Sent to Legal: 2020-06-15
Completed: 2020-08-13
Requester Name: Lisa Williams
Document 1: ExpJun2021 FY21 GSU pdf
Document 2:
Document 3:
Comment: 8/10/20 to facility for final signatures As of 3/30/2020 GDC email addresses will be deactivated. Please contact me at EWARNOCK@AUGUSTA.EDU only.

 
Georgia Gynecology, PC
School of Nursing
Mojgan Khatami
Phone: 770-427-2533
1690 Stone Village Lane Suite 401
Kennesaw GA 30152
Agency Email: dr.khatami@gagynecology.com
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-04
Sent to Provost: 2014-08-11
Sent to Legal:
Completed: 2014-08-19
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Physiotherapy Associates
Department of Physical Therapy
Melanie Walls
Phone: 484-798-1035
1905 SE 16th Street
Cape Coral FL 33990
Agency Email: Melanie.Walls@physiocorp.com
Expiration Date:
Sent to Facility: 2017-08-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: MOU Emailed

 
Essential Family Care
School of Nursing
Sheryl Canady
Phone: 678-609-6282
1775 Parker Road SE
Conyers GA 30094
Agency Email: sheryl.canady@lpnt.net
Expiration Date: 2020-09-30
Sent to Facility: 2017-07-13
Sent to Provost: 2017-09-26
Sent to Legal:
Completed: 2017-10-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Center For Integrative Health, Inc.
School of Nursing
Ayesha Shaikh
Phone: 404-255-5774
755 Mt. Vernon Hwy, NE Suite 350
Atlanta GA 30328
Agency Email: cih.healthcare@gmail.com
Expiration Date: 2017-08-31
Sent to Facility: 2014-08-07
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-11-14
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
The Clinic for All
School of Nursing
Henry Watson
Phone: 404-559-5190
1795 Washington Road
East Point GA 30344
Agency Email: mparks@theclinicforall.com
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-19
Sent to Provost: 2014-08-25
Sent to Legal:
Completed: 2014-09-18
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Buford City schools
Department of Nutrition
Megan Gower
Phone: 770-945-5035
2625 Sawnee Avenue
Buford GA 30518
Agency Email: Megan.gower@bufordcityschools.org
Expiration Date: 2017-08-31
Sent to Facility: 2014-08-27
Sent to Provost: 2014-12-12
Sent to Legal:
Completed: 2014-12-18
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Eagles Landing OB/GYN Associates, PC
School of Nursing
Jackie Livingston
Phone: 770-474-1919 x 151
350 Country Club Drive Suite D
Stockbridge GA 30281
Agency Email: jackie@elobgynassoc.com
Expiration Date: 2017-08-31
Sent to Facility: 2014-08-27
Sent to Provost: 2014-08-28
Sent to Legal:
Completed: 2017-08-31
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
Prestige Healthcare Atlanta
School of Nursing
Charis Trench-Simmons
Phone: 404-346-7100
2886 Princeton Lakes Way
Atlanta GA 30331
Agency Email: lwilliams@phcareatl
Expiration Date: 2017-08-31
Sent to Facility: 2014-08-27
Sent to Provost: 2014-08-28
Sent to Legal:
Completed: 2014-09-12
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:

 
CPM OB/GYN
School of Nursing
Deb Carpenter
Phone: 770-888-3102
5720 Buford Hwy Suite 102
Norcross GA 30071
Agency Email: cpmobgyn@gmail.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-07
Sent to Provost: 2017-10-27
Sent to Legal:
Completed: 2017-11-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covers Norcross and Cumming Locations. agreement expired ; new mou sent 9/7 complete

 
Family Practice & Urgent Care
BFLCNHP
Eastlyn Harding-Marin
Phone: 678-625-5431
3812 Salem Road
Covington GA 30016
Agency Email: hardma@msn.com
Expiration Date: 2021-05-31
Sent to Facility: 2018-05-31
Sent to Provost: 2018-09-24
Sent to Legal:
Completed: 2018-09-27
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:

 
Clinica Medica Prenatal, Inc.
BFLCNHP
Esmerardo Cruz
Phone: 404-636-8282
4300 Buford Highway Suite 216
Atlanta GA 30345
Agency Email: esmerardo@msn.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-23
Sent to Provost: 2019-01-23
Sent to Legal:
Completed: 2019-02-12
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:

 
Athens Womens Clinic, LLP
School of Nursing
James Leon Smith
Phone: 706-548-1388
1270 Prince Avenue Suite 201
Athens GA 30606
Agency Email: bparker60@aol.com
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-12
Sent to Provost: 2014-08-15
Sent to Legal:
Completed: 2014-08-29
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Encompass Health Sea Pines Rehabilitation Hospital
Department of Occupational Therapy
Ryanna Smith-Torres
Phone: 321 984 4602
101 E Florida Avenue
Melbourne FL 32901
Agency Email: ryanna.smith-torrespileggi@encompasshealth.com
Expiration Date: 2022-03-31
Sent to Facility:
Sent to Provost: 2020-04-10
Sent to Legal: 2020-04-10
Completed: 2020-05-04
Requester Name: Jennifer Nelson
Document 1: ExpMar2021 EncompassSeaPines_Apr2020 (002) - signed
Document 2:
Document 3:

 
Mason Primary Care
School of Nursing
Sandra Mason
Phone: 770-476-3636
3550 McClure Bridge Rd, NW
Duluth GA 30096
Agency Email: beth@masonprimarycare.com
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-13
Sent to Provost: 2014-08-22
Sent to Legal:
Completed: 2014-08-29
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Willing Helpers Medical Clinic
School of Nursing
Ed Jenkins
Phone: 678-794-9462
8111 Brown Bridge Road
Covington GA 30014
Agency Email:
Expiration Date: 2017-07-31
Sent to Facility: 2014-08-19
Sent to Provost: 2014-09-03
Sent to Legal:
Completed: 2014-09-18
Requester Name: Kenya Kirkendoll
Document 1: view
Document 2:
Document 3:

 
Grady Memorial Hospital Corporation d/b/a Grady Health System-RT
Department of Respiratory Therapy
Cynthia Alexander
Phone: 404-616-2270
Respiratory Care Services 80 Jesse Hill Jr. Drive
Atlanta GA 30303
Agency Email: calexander@gmh.edu
Expiration Date: 2020-06-01
Sent to Facility: 2017-02-15
Sent to Provost:
Sent to Legal:
Completed: 2018-05-04
Requester Name: Chip Zimmerman
Document 1: Grady RT Only expires Jun2020
Document 2:
Document 3:

 
Wingard Urgent Care & Wellness
School of Nursing
Leslie Lowery
Phone: 770-692-7575
1325 Commerce Drive
Peachtree City GA 30269
Agency Email: llowery@immediatecasrecenters.com
Expiration Date: 2017-08-31
Sent to Facility: 2014-09-10
Sent to Provost: 2014-09-16
Sent to Legal:
Completed: 2014-10-01
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Eclipse Center
School of Nursing
Einat Toledano
Phone: 404-510-2114
4271 First Avenue
Tucker GA 30084
Agency Email: eclipsecenter1@yahoo.com
Expiration Date: 2017-11-30
Sent to Facility: 2014-09-17
Sent to Provost: 2014-12-05
Sent to Legal:
Completed: 2014-12-18
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Take Care Employer Solutions
School of Nursing
Jonathan Cueto
Phone: 770-413-1065
584 Lanier Park Drive
Gainesville GA 30501
Agency Email: Jonathan.cueto@takecare@gmail.com
Expiration Date:
Sent to Facility: 2014-10-22
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-12-08
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: NO EXPIRATION DATE. MAY BE TERMINATED BY EITHER PARTY WITH 30 DAY NOTICE.

 
Family Medicine Clinic of Lawrenceville, LLC
School of Nursing
Irandathy Rodrigo
Phone: 678-225-5540
2522 Cruse Street C2
Lawrenceville GA 30044
Agency Email: irandyrodrigo@yahoo.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-08
Sent to Provost: 2016-12-13
Sent to Legal:
Completed: 2017-01-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
St. Marys Health Care System
Byrdine F Lewis School of Nursing and Health Professions
Kim Hemphill
Phone: 706-389-2150
1230 Baxter Street
Athens Georgia 30606
Agency Email: klawrence@stmarysathens.org
Expiration Date: 2024-08-31
Sent to Facility: 2019-11-07
Sent to Provost: 2019-07-18
Sent to Legal: 2019-07-16
Completed: 2019-11-11
Requester Name: Carla Huggins
Document 1: Exp Aug 2024
Document 2:
Document 3:
Comment: 7/16/20 updated COI requested from GSU Risk Mgmt

 
Quality Living Services, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Irene Richardson
Phone: 4043493026
P.O. Box 311045
Atlanta GA 30331
Agency Email: qls1@co.fulton.ga.us
Expiration Date: 2022-04-30
Sent to Facility: 2019-04-12
Sent to Provost: 2019-05-02
Sent to Legal:
Completed: 2019-05-09
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please carbon copy the following email on all email correspondence: lacefies@bellsouth.net

 
Planted in Nutrition LLC
Department of Nutrition
Julia Wallace
Phone: 470-223-2314
1229 Johnson Ferry Rd Ste 102
Marietta Ga 30068
Agency Email: juliewallce@plantedinnutrition.com
Expiration Date: 2024-08-31
Sent to Facility: 2018-08-31
Sent to Provost: 2018-09-12
Sent to Legal:
Completed: 2021-07-21
Requester Name: jessica todd
Document 1: Final copy Planted in Nutrition LLC
Document 2:
Document 3:
Comment: renew clinical

 
Advance Rehabilitation & Consulting
Department of Physical Therapy
Dan Allcott
Phone: 706-235-2727
224 Shorter Avenue
Rome GA 30165
Agency Email: dallcott@advancerehab.com
Expiration Date: 2024-03-18
Sent to Facility: 2017-04-18
Sent to Provost: 2017-05-18
Sent to Legal:
Completed: 2022-05-20
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: U.S. Physical Therapy, Inc.

 
Dr. Larry D. Stewart Jr
BFLCNHP
Kathy ONeill
Phone: 478-751-2580
300 Margie Drive
Perry GA 31088
Agency Email: oneillk@cstonemed.com
Expiration Date: 2021-05-31
Sent to Facility: 2018-04-04
Sent to Provost: 2018-05-14
Sent to Legal:
Completed: 2018-05-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Practice closed as of 12/2019. LYW

 
Friends of Refugees - Nursing
BFLCNHP
Jennifer Green
Phone: 404-292-8818
1042 Rowland Street
Clarkston GA 30021
Agency Email: jennifer@friendsofrefugees.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-13
Sent to Provost: 2018-01-04
Sent to Legal:
Completed: 2018-01-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Georgia Pines Community Service Board
BFLCNHP
Robert Hurn
Phone: 229-255-5033
1102 Smith Street
Thomasville GA 31792
Agency Email: rjhurn@georgiapines.net
Expiration Date: 2025-12-31
Sent to Facility: 2017-12-13
Sent to Provost: 2018-01-29
Sent to Legal:
Completed: 2021-12-17
Requester Name: Lisa w
Document 1:
Document 2:
Document 3:
Comment: complete

 
SportsCare Physical Therapy
Department of Physical Therapy, Inc.
Jeff Lewandowski
Phone: 770-495-0610
6920 McGinnis Ferry Rd Suite 320
Suwanee Georgia 30024
Agency Email: Jlewandowski@sportscarephysicaltherapy.com
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-22
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu

 
ACTS Therapy
Department of Occupational Therapy
Karin Shah
Phone: 678-884-5085
500 Lanier Ave. W Suite 702 + 703
Fayetteville GA 30214
Agency Email: Karin.shaw1@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:

 
Dunwoody Womens Medical Group
School of Nursing
Andrea Pickens
Phone: 770-454-8080
3114 Mercer University Drive Suite 100
Atlanta GA 30341
Agency Email: dwmgweb@gmail.com
Expiration Date: 2017-09-30
Sent to Facility: 2014-10-06
Sent to Provost: 2014-10-09
Sent to Legal:
Completed: 2014-10-23
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Druid Hills Primary Care
BFLCNHP
Diane Canales
Phone: 404-228-2648
1700 Briarcliff Road, NE
Atlanta GA 30306
Agency Email: druidhillsprimarycare@gmail.com
Expiration Date: 2023-04-30
Sent to Facility: 2020-04-27
Sent to Provost: 2020-05-22
Sent to Legal:
Completed: 2020-08-06
Requester Name: Lisa Williams
Document 1: ExpApril2023 DruidHillsPrimaryCare April2020 signed
Document 2:
Document 3:

 
Signature Womens Healthcare, LLC
School of Nursing
Charles Spotts
Phone: 678-380-1200
771 Old Norcross Road Suite 350
Lawrenceville GA 30046
Agency Email: cspotts@awhg.org
Expiration Date: 2017-09-30
Sent to Facility: 2014-10-06
Sent to Provost: 2014-10-17
Sent to Legal:
Completed: 2014-11-03
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
ES Rehabilitation, LLC d/b/a Emory Rehabilitation Hospital
Department of Physical Therapy
Scott Rotsted
Phone: (404) 712-2574
1441 Clifton Rd
Atlanta Georgia 30322
Agency Email: scott.rotsted@emoryhealthcare.org
Expiration Date: 2017-12-31
Sent to Facility: 2015-12-07
Sent to Provost: 2016-11-29
Sent to Legal:
Completed: 2017-01-13
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: 1 YEAR AGREEMENT.

 
Genesis Healthcare Associates, PC
School of Nursing
Danita Kinney
Phone: 770-434-1904
3903 S. Cobb Drive, SE Suite 225
Smyrna GA 30080
Agency Email: Genesis.Admin@genesishca.net
Expiration Date: 2020-10-31
Sent to Facility: 2017-05-31
Sent to Provost: 2017-06-27
Sent to Legal:
Completed: 2017-07-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/9/2020 - this site charges a few and cannot be used by students

 
Northside Hospital, Inc.-Adv RN
School of Nursing
Marsha Blakey
Phone: 404-236-8078
1000 Johnson Ferry Road, NE
Atlanta GA 30342-1611
Agency Email: marsha.blakey@northside.com
Expiration Date:
Sent to Facility:
Sent to Provost: 2016-10-25
Sent to Legal:
Completed: 2016-11-10
Requester Name: Lisa Williams
Document 1: northside-hosp-inc-RN_001.pdf
Document 2:
Document 3:
Comment: Auto-renews annually for one-year terms. 4/30/19 Sent email to M. Blakey asking best way to add PT to the existing auto-renewing MOU. 1/15/2020 addendum adding DNP students to Blakey for final signatures

 
OBGYN Center
School of Nursing
Hyacinth Crooks
Phone: 678-722-8930
875 Old Roswell Road Suite F100
Roswell GA 30076
Agency Email: cmg.roswell@gmail.com
Expiration Date: 2017-08-31
Sent to Facility: 2014-09-04
Sent to Provost: 2014-09-09
Sent to Legal:
Completed: 2014-09-15
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Physicians for Children d/b/a Childrens Health Pediatric Group
School of Nursing
Crystal Thompson
Phone: 214-456-6712
2777 N. Stemmons Freeway Suite 825
Dallas TX 75207
Agency Email: crystal.thompson@my-childrens.com
Expiration Date: 2017-12-31
Sent to Facility: 2014-10-22
Sent to Provost: 2015-01-05
Sent to Legal:
Completed: 2015-01-16
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Fully executed MOU mailed to Agency 1/20.

 
New London Health Center
School of Nursing
Altovise Vertus
Phone: 770-674-4888
2020 McGee Road
Snellville GA 30078
Agency Email: altovise.vertus@eastsideneurorehab.com
Expiration Date: 2019-02-28
Sent to Facility: 2016-03-14
Sent to Provost: 2016-03-21
Sent to Legal:
Completed: 2016-04-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Progressive Medical Center
BFLCNHP
Katie Atwell
Phone: (770) 676-6000
4646 North Shallowford Rd
Atlanta Ga 30338
Agency Email: ssultan@progressivemedicalcenter.com
Expiration Date: 2021-07-31
Sent to Facility: 2018-07-12
Sent to Provost: 2018-07-16
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Peachtree City Office, Woodstock, Dunwoody MOU complete.. sent to all parties 7/12/18 Sent updated contract to include BFLCNHP 7/16/18 to Legal 8/8/18 emailed complete updated mou to all parties

 
Spine and Sport
Department of Physical Therapy
Zach Jerrell
Phone: (912) 459-2230
201 Business Park Drive Suite 204
Rincon GA 31326
Agency Email: ccce@spinesport.org
Expiration Date: 2017-10-31
Sent to Facility: 2014-10-30
Sent to Provost: 2014-10-31
Sent to Legal:
Completed: 2014-12-08
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.

 
Center for Discovery
Department of Nutrition
Hannah Sabella
Phone: 618-670-1390
1364 Manget Way
Dunwoody Ga 30338
Agency Email: hannah.sabella@centerfordiscovery.com
Expiration Date: 2020-10-31
Sent to Facility: 2020-09-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: 9/1/20 email undeliverable, left message on facility voicemail system.

 
Mercy Care Inc.
BFLCNHP
Brandied McClain
Phone: 678-843-8973
424 Decatur Street, NE
Atlanta GA 30312
Agency Email: brandied.mcclain@mercyatlanta.org
Expiration Date: 2025-4-30
Sent to Facility: 2019-01-17
Sent to Provost: 2019-01-30
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: Mercy Care 2015 Contract
Document 2:
Document 3:

 
Med Care Adairsville, LLC
School of Nursing
Pat Geer
Phone: 770-773-9902
14 Legacy Way
Adairsville GA 30103
Agency Email: medadairsville@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-03-04
Sent to Legal:
Completed: 2020-03-06
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...6132012 pdf
Document 2:
Document 3:

 
Southeastern Endocrine & Diabetes, PC
BFLCNHP
Ann Rosenbaum
Phone: 678-325-2250
1475 Holcomb Bridge Road Suite 129
Roswell GA 30076
Agency Email: arosenbaum@seedreed.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-04
Sent to Provost: 2018-01-24
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Atlanta Community Food Bank
Department of Nutrition
Kristen Elliott
Phone: 678-538-9970
732 Joseph E. Lowery Blvd., NW
Atlanta GA 30318
Agency Email: kristen.elliott@acfb.org
Expiration Date: 2023-08-31
Sent to Facility: 2020-08-05
Sent to Provost: 2020-08-18
Sent to Legal:
Completed: 2021-02-05
Requester Name: Jessica Todd
Document 1: Atlanta Community Food Bank_02-05-21
Document 2:
Document 3:
Comment: Non clinical agreement

 
Diabetes and Endocrinology Associates, PC
Department of Nutrition
Jennifer Rushing
Phone: 404-299-2223 ext 112
2665 North Decatur Road Suite 520/ Nutrition Department
Decatur Georgia 30303
Agency Email: jenmrushing@gmail.com
Expiration Date:
Sent to Facility: 2014-11-05
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: MOU e-mailed

 
Gwinnett Public Schools
Department of Nutrition
Taylor Blake
Phone: 678-301-6245
437 Old Peachtree Rd
Suwanee GA 30024
Agency Email: taylor.blake@gcpsk12.org
Expiration Date: 2020-10-31
Sent to Facility: 2017-04-21
Sent to Provost: 2017-04-25
Sent to Legal:
Completed: 2020-10-20
Requester Name: Jessica Todd
Document 1: Gwinnett Public Schools_2020-10-20
Document 2:
Document 3:
Comment: NOn-clinical agreement; would prefer electronic submission. Sent affiliation agreement to facility 10-14-20 Wgl

 
Roswell Pediatrics Center PC
BFLCNHP
Laurie Viebrock
Phone: 770-751-0800
12385 Crabapple Road
Alpharetta GA 30004
Agency Email: laurieviebrock@gmail.com
Expiration Date: 2025-03-14
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-20
Sent to Legal:
Completed: 2022-05-03
Requester Name: Lisa Williams
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Covers all 3 practice offices (Alpharetta, Crapapple & Cumming).

 
Metro Community Healthcare
School of Nursing
Anne Freckleton
Phone: 678-580-5958
1462 Montreal Road West Suite 201
Tucker GA 30084
Agency Email: info@metrochc.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-06
Sent to Provost: 2017-09-15
Sent to Legal:
Completed: 2017-09-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: mou complete sent to all parties

 
Roswell Nutrition
Department of Nutrition
Karen Porter
Phone: 404-735-4850
5825 Glenridge Drive Building 3, Suite101
Atlanta GA 30328
Agency Email: karen@roswellnutrition.com
Expiration Date: 2017-11-30
Sent to Facility: 2014-11-14
Sent to Provost: 2015-02-12
Sent to Legal:
Completed: 2015-02-19
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:

 
Jay Medical and Rehab Works, PC
School of Nursing
Hardevi Nariani
Phone: 678-714-8522
3457 Lawrenceville Suwanee Rd Suite C
Suwanee GA 30024
Agency Email: jaymedicalclinic.ga@gmail.com
Expiration Date: 2022-07-31
Sent to Facility: 2019-07-01
Sent to Provost: 2019-07-15
Sent to Legal:
Completed: 2019-08-29
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
Comment: Dr. Sanjay Nariani

 
Shiraz H Kassam MD
School of Nursing
Mubina Mawji
Phone: 770-922-2424
1380 Milstead Avenue Suite B
Conyers GA 30012
Agency Email: mubinamawji@aol.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-08-25
Sent to Provost: 2017-08-25
Sent to Legal:
Completed: 2017-09-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: mou complete

 
Omega Pediatrics
School of Nursing
Michael Nwaneri
Phone: 470-485-6342
1305 Hembree Road Suite 203
Roswell GA 30076
Agency Email: nwaneri@omegapediatrics.com
Expiration Date: 2020-04-30
Sent to Facility: 2017-04-19
Sent to Provost: 2017-05-08
Sent to Legal:
Completed: 2017-05-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Jody Amazon, PC
School of Nursing
Jody Amazon
Phone: 770-982-1111
2160 Fountain Drive Suite 200
Snellville GA 30078
Agency Email: jamazon@bellsouth.net
Expiration Date: 2017-11-30
Sent to Facility: 2014-11-18
Sent to Provost: 2014-11-24
Sent to Legal:
Completed: 2018-12-18
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:

 
Image Bearers Ministries
School of Nursing
David Sims
Phone: 770-461-2910
115 Kathi Avenue
Fayetteville GA 30214
Agency Email: davidbsims@comcast.net
Expiration Date: 2020-10-31
Sent to Facility: 2017-10-02
Sent to Provost: 2017-11-28
Sent to Legal:
Completed: 2017-12-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete

 
Childrens Clinic LLP
School of Nursing
Natalie Autry
Phone: 478-272-2623
2406 Bellevue Rd Bldg 10
Dublin GA 31021
Agency Email: nbautry@bellsouth.net
Expiration Date: 2017-11-30
Sent to Facility: 2014-11-19
Sent to Provost: 2015-03-04
Sent to Legal:
Completed: 2015-03-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Childrens Medical Group
BFLCNHP
Faisal Saleem
Phone: 404-633-4595
1875 Century Blvd Suite 150
Atlanta GA 30345
Agency Email: fsaleem@cmg-pc.com
Expiration Date: 2024-04-30
Sent to Facility: 2017-11-03
Sent to Provost: 2017-11-03
Sent to Legal:
Completed: 2021-04-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:

 
Senior Connections
School of Nursing
Liza Benton
Phone: 770-455-7602 ext 119
5238 Peachtree Road
Chamblee GA 30341-2718
Agency Email: lbenton@seniorconnectionsatl.org
Expiration Date:
Sent to Facility: 2014-11-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: JoAnn Bacon
Document 1:
Document 2:
Document 3:
Comment: Send Amendment to Nutrition MOU

 
Advance Rehabilitation and Physical Therapy
Department of Physical Therapy
Allison Nourie
Phone: 404.367.2083
3223 Howell Mill Rd.
Atlanta GA 30327
Agency Email: anourie@advancerehab.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu

 
Emory Healthcare H.I.
Health Informatics
Todd Settlemyre
Phone: NA
57 Executive Park
Atlanta Georgia 30329
Agency Email: NA
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-04
Sent to Provost: 2018-01-31
Sent to Legal:
Completed: 2018-02-15
Requester Name: Cedric Truss
Document 1: Emory Health Info pdf
Document 2:
Document 3:
Comment: complete

 
Community Service Board of Middle Georgia
School of Nursing
Linda Melton
Phone: 478-272-1190
2121-A Bellevue Road
Dublin GA 31021
Agency Email: lmelton@csbmg.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-20
Sent to Provost: 2015-02-02
Sent to Legal:
Completed: 2015-02-19
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:

 
Good News Clinics - Nutrition
Department of Nutrition
Karen Hunter
Phone: 770-503-1369 x 310
PO BOX 2683
Gainesville Ga 30303
Agency Email: karenh@goodnewsclinics.org
Expiration Date: 2020-08-31
Sent to Facility: 2017-08-01
Sent to Provost: 2017-09-14
Sent to Legal:
Completed: 2017-09-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: 3/31/20 Renewal initiated by Nursing

 
Gwinnett Center Medical Associates, PC
School of Nursing
Heather Noblett
Phone: 770-277-8554
748 Old Norcross Road Suite 185
Lawrenceville, GA 30046
Agency Email: rnoblett7@bellsouth.net
Expiration Date:
Sent to Facility: 2014-12-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: MOU e-mailed

 
Bridge Atlanta Medical Center
School of Nursing
LeRoy Graham
Phone: 770-806-0162
4864 Jimmy Carter Boulevard Suite 203
Norcross GA 30093-3704
Agency Email: LeRoy.Graham@BridgeAMC.org
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-17
Sent to Provost: 2017-03-30
Sent to Legal:
Completed: 2017-04-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/26/2020-Site is now a part of Good Samaritan of Gwinnett.LYW

 
Lets Talk Therapy LLC
Department of Occupational Therapy and Department of Physical Therapy
Teddy Fayne
Phone: 800 381 2195
4500 Satellite Blvd. ste 2250
Duluth Ga 30096
Agency Email: teddy@lttnow.com
Expiration Date: 2023-02-28
Sent to Facility: 2019-11-22
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2020-02-11
Requester Name: Shana Finks
Document 1: exp feb 2023 ...213165229pdf
Document 2:
Document 3:

 
Northside Urgent Care
Health Informatics
Mario Rivera
Phone: 404-321-4692
3367 Buford Highway Suite 910
Brookhaven Georgia 30329
Agency Email: Clinicaunion@hotmail.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-24
Sent to Provost: 2018-01-29
Sent to Legal:
Completed: 2018-02-01
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: complete

 
The Womens Center
School of Nursing
Jill Weiss
Phone: 706-845-0500
310 South Lewis Street
LaGrange GA 30240
Agency Email: jillannweiss@gmail.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-06
Sent to Provost: 2015-01-16
Sent to Legal:
Completed: 2015-02-10
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Emailed and mailed copy to Agency 2/12/15.