YOUR SEARCH RESULTS
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Rural Urgent Care, LLC
School of Nursing
Madison Lunday
Phone: 205-504-7150
1500 1st Avenue North Unite 3
Birmingham AL 35203
Agency Email: mlunday@mainstreetfamilycare.com
Expiration Date: 2026-12-05
Sent to Facility:
Sent to Provost: 2023-12-06
Sent to Legal:
Completed: 2023-12-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: sent partially exec agreement to facility 12/07/23
Rural Urgent Care, LLC, a Delaware limited liability company,
MainStreet and KidsStreet of North Carolina, PLLC,
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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: 2022-09-30
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
1-31-23 Sent template to Joi sent coi request to Bibbs and Lajanda
12-02-23 Sent W-9 to facility
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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
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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:
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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:
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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:
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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:
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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: 2027-10-31
Sent to Facility:
Sent to Provost: 2024-03-26
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
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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:
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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: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: complete
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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: 2026-01-31
Sent to Facility:
Sent to Provost: 2020-02-19
Sent to Legal:
Completed: 2023-08-10
Requester Name: Jennifer Nelson
Document 1: AllAboutKids ExpAug2020.pdf
Document 2: Exp Jan 2023 All About Kids Theraphy.pdf
Document 3:
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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:
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Alpharetta Pediatrics
BFLCNHP
Sandy Farrell
Phone: 770.664.4430
1100 Northmeadow Pkwy Suite 108
Roswell GA 30076
Agency Email: alphapeds@yahoo.com.
Expiration Date: 2026-05-31
Sent to Facility: 2020-06-03
Sent to Provost: 2020-06-03
Sent to Legal:
Completed: 2023-05-18
Requester Name: Lisa Williams
Document 1: ExpMay2023 AlpharettaPeds for Provost signed pdf
Document 2:
Document 3:
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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: 2027-03-31
Sent to Facility: 2024-01-24
Sent to Provost: 2024-02-07
Sent to Legal:
Completed: 2024-02-08
Requester Name: Carla Huggins
Document 1: Alternative Back Care_exp3-31-2024
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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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:
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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:
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AnMed Health
Department of Physical Therapy
Hannah Ward
Phone: 864-512-1196
800 North Fant Street Rehabilitation Services Department
Anderson SC 29621-9983
Agency Email: hanna.ward@anmed.org
Expiration Date: 2024-03-31
Sent to Facility: 2024-01-24
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:
Comment: Please copy ptclinicaleducation@gsu.edu
Facility prefers to use their own template
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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:
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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:
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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:
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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:
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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
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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
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Primary Pediatrics
School of Nursing
LaDonna Snider
Phone: 478-741-3007 (ext. 1108)
5300 Bowman Road
Macon GA 31210
Agency Email: snider_ladonna@primarypediatrics.com
Expiration Date: 2026-3-31
Sent to Facility: 2017-11-15
Sent to Provost:
Sent to Legal:
Completed: 2023-04-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/21/23 - Covers all locations: Macon, Warner Robins, Forsyth,
Bonaire and McDonough. LYW
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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:
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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:
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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: 2025-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-6-15
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: This needs to be restarted. It expired.
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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:
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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:
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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:
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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: 2026-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-03
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
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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:
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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: 2026-04-30
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-17
Sent to Legal:
Completed: 2023-03-30
Requester Name: Carla Huggins
Document 1: Final Expires October 2022 1130905
Document 2:
Document 3:
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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.
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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.
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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: 2024-03-26
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.
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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:
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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.
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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
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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:
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Avita Community Partners
BFLCNHP
Lori Holbrook
Phone: 678-960-2704
4331 Thurmon Tanner Pkwy
Flowery Branch GA 30542
Agency Email: lori.holbrook@avitapartners.org
Expiration Date: 2023-07-31
Sent to Facility: 2023-06-13
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:
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Advance Rehabilitation for Kids of Gordon Co
Department of Occupational Therapy
Megan Taylor
Phone: 706-624-3000
1114 S. Wall Street
Calhoun GA 30701
Agency Email: clinicaleducation@advancerehab.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-01-24
Sent to Provost: 2024-02-08
Sent to Legal:
Completed: 2024-02-08
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
Comment: Please copy PTClinicalEducation@gsu.edu
Multiple locations:
212 W. 3rd Street, Rome, GA 30165
Phone: 706-295-4242
Fax: 706-295-4260
100 Lindsey Ln
Kingsland, GA 31548
(912) 510-6104
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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:
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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 !!
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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:
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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.
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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:
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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:
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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
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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:
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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:
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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:
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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
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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:
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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: 2027-02-28
Sent to Facility: 2024-01-19
Sent to Provost: 2024-02-28
Sent to Legal:
Completed: 2024-03-06
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Candler County Hospital
Byrdine F Lewis School of Nursing and Health Professions
Ashley Fulmer
Phone: 912-685-5741
P O Box 597
Metter GA 30439
Agency Email: afulmer@candlercountyhospital.com
Expiration Date: 2026-02-28
Sent to Facility: 2019-02-28
Sent to Provost:
Sent to Legal:
Completed: 2023-07-14
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy Masiki Williamson on communication at
ptclinicaleducation@gsu.edu. Thank you.
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Wylde Center, LLC
Department of Nutrition
Stephanie Van Parys
Phone: 6786424977
435 Oakview Rd
Decatur Ga 30030
Agency Email: stephanie@wyldecenter.org
Expiration Date: 2025-10-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-28
Sent to Legal:
Completed: 2022-08-18
Requester Name: Jessica Todd
Document 1: Exp Oct 2022 doc03516320191030160920
Document 2:
Document 3:
Comment: Non Clinical Contract
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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:
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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.
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Center For Black Womens Wellness Inc.
BFLCNHP
Tonya Young
Phone: 404-688-9202
477 Windsor Street, SW Suite 309
Atlanta GA 30312
Agency Email: tyoung@cbww.org
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Center For Black Womens Wellness Inc.
Document 2:
Document 3:
Comment:
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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
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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:
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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:
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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
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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
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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
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Cherokee County School District
Department of Nutrition
Linda Dittrich
Phone: 770-721-8418
135 Mountain Brook Drive Bldg F
Canton GA 30115
Agency Email: Trang.Pham@cherokeek12.net
Expiration Date: 2027-8-17
Sent to Facility: 2023-08-08
Sent to Provost:
Sent to Legal:
Completed: 2022-8-22
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Auto renewal_9-23-22
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.
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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
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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: 2024-03-07
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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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: 7/15/2016
Sent to Facility: 2023-08-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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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
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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:
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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:
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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
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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:
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Coker Pediatrics, LLC
School of Nursing
Michelle Corbin
Phone: 678-688-1580
14557 Highyway 19 Suite A
Griffin GA 30224-9582
Agency Email: mcorbin@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:
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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
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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)
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Our House, Inc.
School of Nursing
Tyreesha Hubbard
Phone: 404-658-1500
173 Boulevard NE
Atlanta GA 30312
Agency Email: Tyreesha.Hubbard@capn.org
Expiration Date: 2026-04-30
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:
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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:
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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: 2024-04-30
Sent to Facility: 2018-11-20
Sent to Provost:
Sent to Legal:
Completed: 2022-9-15
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
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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.
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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.
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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:
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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
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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
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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: 2024-04-10
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:
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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
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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:
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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: 2025-12-31
Sent to Facility: 2017-11-28
Sent to Provost: 2018-01-01
Sent to Legal:
Completed: 2022-08-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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:
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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: 2027-07-26
Sent to Facility: 2019-06-10
Sent to Provost: 2019-06-03
Sent to Legal: 2019-01-24
Completed: 2022-07-27
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
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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:
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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
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DCH Health System
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: 2022-10-31
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: Please email ptclinicaleducation@gsu.edu
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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: 2022-04-14
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
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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
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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: 2023-12-31
Sent to Facility: 2019-09-18
Sent to Provost:
Sent to Legal: 2019-10-07
Completed: 2022-10-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 1/13/23-Contract will exp 12/31/23 with option to renew for 4
additional years
11/22/19 Cannot agree to contract terms. Facility requires GSU
provide free classes to their staff.
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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:
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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: 2021-07-30
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.
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|
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:
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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:
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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
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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
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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:
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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:
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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: 2024-03-28
Sent to Provost: 2014-11-10
Sent to Legal:
Completed: 2014-11-18
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Nonclinical
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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:
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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
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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: 2022-01-13
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
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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:
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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
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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:
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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: 2026-11-30
Sent to Facility:
Sent to Provost: 2024-01-11
Sent to Legal:
Completed: 2024-01-18
Requester Name: Thomas
Document 1: view
Document 2:
Document 3:
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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:
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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:
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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
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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:
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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:
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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:
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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.
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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:
Comment: Nonclinical
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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.
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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: 2024-03-21
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
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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:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment: Requesting renewal
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Associated Therapies
Department of Occupational Therapy
Humera Savaja
Phone: 404-728-9766
1456 McLendon Dr
Decatur GA 30033
Agency Email: humera@associatedtherapies.com
Expiration Date:
Sent to Facility: 2023-04-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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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
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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
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Eastside Medical Center
Department of Physical & 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: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Division of Tristar, covered under Tristar Health System
Inc.
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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
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Emory Healthcare, Inc.
Physical Therapy
Elizabeth Botheroyd
Phone: 404-686-2429
550 Peachtree Street
Atlanta GA 30308
Agency Email: elizabeth.botheroyd@emoryhealthcare.org
Expiration Date: 2026-08-29
Sent to Facility:
Sent to Provost: 2020-04-24
Sent to Legal:
Completed: 2023-06-27
Requester Name: Carla Huggins
Document 1: Final Expires August 2020
Document 2: Amendment to add RT
Document 3: Exp Aug 2023 ...Emory GSU Nursing pdf
Comment: Requested to add OT and PT students: Dept handling OT/PT
requests will respond if interested in training for PT
students. 3/21/2024
Please copy ptclinicaleducation@gsu.edu
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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:
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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: 2026-08-31
Sent to Facility: 2026-08-31
Sent to Provost: 2024-01-02
Sent to Legal:
Completed: 2024-01-11
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
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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.
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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
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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
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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: 2024-03-20
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.
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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
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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: 2023-07-06
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
Receive email delivery error 7/06/23
Phone: 706-282-4200
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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
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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:
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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:
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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:
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Sovereign Rehabilitation
Department of Physical 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: 2023-03-29
Sent to Provost: 2020-01-24
Sent to Legal:
Completed: 2020-01-30
Requester Name: Carla Huggins
Document 1: exp dec 2022 ...4122632.pdf
Document 2:
Document 3:
Comment: Lawrenceville & Atlanta locations
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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:
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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
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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.
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Sports Medicine of Atlanta, Inc.
Department of Physical Therapy
Robert E DuVall
Phone: 770-979-1400
2138 Scenic Highway Suite B
Snellville GA 30078
Agency Email: rduvall@sportsmedicineofatlanta.com
Expiration Date: 2021-03-31
Sent to Facility: 2023-07-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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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
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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.
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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:
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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
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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
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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:
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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:
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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:
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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: 2026-04-04
Sent to Facility: 2020-03-17
Sent to Provost: 2020-03-23
Sent to Legal:
Completed: 2023-04-10
Requester Name: Lisa Williams
Document 1: exp mar2023 Tanner Health MOU - signed
Document 2:
Document 3:
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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:
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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: 2022-11-03
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:
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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: 2026-01-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-22
Sent to Legal:
Completed: 2022-11-30
Requester Name: Jennifer Nelson
Document 1: Expires January 2020 PT ONLY
Document 2: Exp Jan 2023 doc03472320191023101926
Document 3:
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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
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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
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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:
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The Childrens Hospital of Alabama
Department of Physical Therapy
Martha Dorough
Phone: 205-939-9889
1600 7th Avenue South
Birmingham AL 35233
Agency Email:
Expiration Date: 2026-12-07
Sent to Facility: 2012-09-18
Sent to Provost: 2012-11-19
Sent to Legal:
Completed: 2024-01-03
Requester Name: Jennifer Cline
Document 1:
Document 2:
Document 3:
Comment: Childrens Hospital, Alabama
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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
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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:
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The East Clinic
BFLCNHP
Lynn Stubelt
Phone: 770-505-0531
539 Hardee Street
Dallas GA 30132
Agency Email: theeastclinic@netscape.net
Expiration Date: 06/30/2025
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:
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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
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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
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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: 2022-06-01
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:
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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.
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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:
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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
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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.
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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:
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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
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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:
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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
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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:
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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:
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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:
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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
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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
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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:
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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
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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: 2026-02-08
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:
Comment: Following the Initial Term, this Agreement shall automatically
renew for additional one-(1) year terms (each, a “Renewal
Term”) unless either party gives written
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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: 2025-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-0--12
Requester Name: McCarroll
Document 1:
Document 2:
Document 3:
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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
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FOX Management Rehabilitation Services, LLC
Department of Physical Therapy
Richard Brown
Phone: 877-407-3422
7 Carnegie Plaza
Cherry Hill NJ 08003
Agency Email: crysta.zuradduryea@foxrehab.org
Expiration Date: 2024-08-31
Sent to Facility: 2024-03-25
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.
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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
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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.
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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:
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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: 2026-07-31
Sent to Facility: 2019-05-23
Sent to Provost: 2024-01-16
Sent to Legal:
Completed: 2024-01-19
Requester Name: Carla Huggins
Document 1: Final Expires September 2022
Document 2:
Document 3:
Comment: Copy chuggins@gsu.edu
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Powerback Rehab
Department of Physical Therapy and Occupational Therapy
Elizabeth Burke
Phone: 610-444-6350
101 East State Street
Kennett Square PA 19348
Agency Email: PowerbackStudentProgram@powerbackrehab.com
Expiration Date: 2021-11-30
Sent to Facility: 2024-03-01
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: sent request on 2023-05-25
Powerback Rehab
Formerly Genesis ElderCare Rehabilitation Services, LLC d/b/a/
Genesis Rehab Services, LLC
mailed contract 5/25/2023
Phone: 610-444-6350
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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
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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:
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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
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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:
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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: 2026-08-31
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-16
Sent to Legal:
Completed: 2023-09-12
Requester Name: Carla Huggins
Document 1: Final Expires April 2022
Document 2:
Document 3:
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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
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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
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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:
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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
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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: 2022-09-19
Sent to Provost: 2020-01-16
Sent to Legal:
Completed: 2020-01-17
Requester Name: Karen McWaters
Document 1: exp dec 2022 HeartsHandsTherapy_Jan2020.pdf
Document 2:
Document 3:
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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: 2026-08-31
Sent to Facility: 2020-05-13
Sent to Provost: 2020-06-18
Sent to Legal:
Completed: 2023-08-24
Requester Name: Carla Huggins
Document 1: ExpOct2023 ProPerformance forProvost signed
Document 2:
Document 3:
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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:
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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: 2024-01-25
Sent to Provost:
Sent to Legal:
Completed: 2021-10-15
Requester Name: Carla Huggins
Document 1: Professional Health Services
Document 2:
Document 3:
Comment: Sent edits to facility 2/06/2024
NHC Healthcare is covered under this contract.
Please copy ptclinicaleducation@gsu.edu on all correspondence.
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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:
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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
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Open Hand Atlanta
Department of Nutrition
Laura Samnadda
Phone: 404-872-8089
181 Armour Drive
Atlanta GA 30324
Agency Email: lsamnadda@openhandatlanta.org
Expiration Date: 2026-09-30
Sent to Facility: 2020-04-29
Sent to Provost: 2020-07-30
Sent to Legal:
Completed: 2023-09-12
Requester Name: Jessica Todd
Document 1: ExpSep2023 OpenHandAtlanta July2020 signed pdf
Document 2:
Document 3:
Comment: Nonclinical
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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: 2024-03-14
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
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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: 2026-04-02
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
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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:
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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:
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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:
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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:
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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: 2026-08-31
Sent to Facility: 2020-06-08
Sent to Provost: 2020-06-15
Sent to Legal:
Completed: 2023-08-30
Requester Name: Jessica Todd
Document 1: ExpMay2023 Signed MOU GSU
Document 2:
Document 3:
Comment: nonclinical
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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
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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:
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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
8/28/2023 - requesting renewal
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Forever Care Ob/Gyn
Byrdine F Lewis School of Nursing and Health Professions
Shirley Cau
Phone: 770-495-4935
3635 Peachtree Industrial Boulevard Suite 150
Duluth GA 30096
Agency Email: forevercareobgyn@gmail.com
Expiration Date: 2026-06-30
Sent to Facility: 2019-12-18
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2023-11-30
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...4122355.pdf
Document 2:
Document 3:
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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
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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
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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
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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:
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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: 2023-09-05
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
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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:
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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: 2022-02-15
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:
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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:
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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)
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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:
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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.
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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
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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: 2025-07-31
Sent to Facility: 2020-09-02
Sent to Provost:
Sent to Legal:
Completed: 2022-08-26
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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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
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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: 2021-05-06
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:
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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:
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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.
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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:
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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:
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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: 2026-06-30
Sent to Facility: 2019-03-28
Sent to Provost: 2019-04-18
Sent to Legal:
Completed: 2023-04-21
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
Contract renewal requests contact:
samantha.nanartowicz@nghs.com
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Harbin Clinic
BFLCNHP
Tonya West
Phone: 762-235-1191
221 Technology Parkway
Rome GA 30165
Agency Email: tonya.west@HarbinClinic.com
Expiration Date: 2027-03-31
Sent to Facility: 2024-03-13
Sent to Provost: 2024-03-20
Sent to Legal:
Completed: 2024-03-20
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
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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:
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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
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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
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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.
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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:
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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:
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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
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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:
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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
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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:
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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: 2026-10-31
Sent to Facility: 2023-03-24
Sent to Provost: 2018-02-14
Sent to Legal:
Completed: 2024-01-11
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Perry Hospital and Pavilion Rehab
Received no response-Sent emails in March and May 2023
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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
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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:
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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:
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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
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IAP Wellness
BFLCNHP
Elizabeth Robinson
Phone: 404-539-0719
289 Little Street
Atlanta GA 30315
Agency Email: lauren@intownatlpsych.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:
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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:
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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:
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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.
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Intown Pediatric and Adolescent Medicine, PC
School of Nursing
Roger Seaton
Phone: 404-446-4726
490 Bill Kennedy Way Suite 101
Atlanta GA 30316
Agency Email: roger@intownpediatrics.com
Expiration Date: 2027-01-16
Sent to Facility: 2024-01-17
Sent to Provost:
Sent to Legal:
Completed: 2024-02-08
Requester Name: Lisa Williams
Document 1: Final Expires October 2022
Document 2:
Document 3:
Comment:
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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:
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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
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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:
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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:
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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:
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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
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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: Waiting on facility to accept edits 3-05-2024
Covers:John D. Archbold Memorial Hospital, Inc. (Including
operations D/B/A Archbold Memorial, Archbold Brooks,
Archbold Grady, Archbold Mitchell, Archbold Living
Thomasville, Archbold Living Camilla, Archbold Living
Pelham, Archbold Living Cairo); Archbold Foundation, Inc.;
and Archbold Medical Group
Submitted Review Request to Legal 1/16/2024
Please copy ptclinicaleducation@gsu.edu
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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:
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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: 2021-04-30
Sent to Provost: 2016-08-19
Sent to Legal:
Completed: 2016-08-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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:
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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
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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:
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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: 2021-02-12
Sent to Provost: 2018-04-12
Sent to Legal:
Completed: 2018-04-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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: 2025-03-31
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:
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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
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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:
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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
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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: 2025-07-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-08-19
Sent to Legal: 2019-07-24
Completed: 2022-05-27
Requester Name: Jessica Todd
Document 1: Final Expires July 2022 - Clinical AND Non-Clinical
Document 2:
Document 3:
Comment: Non Clincial Renewal
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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: 2026-12-31
Sent to Facility: 2017-12-07
Sent to Provost: 2018-01-04
Sent to Legal:
Completed: 2023-03-20
Requester Name: jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non-clinical agreement
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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:
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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:
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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:
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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:
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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: 2021-11-18
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
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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:
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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
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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.
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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:
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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
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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:
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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:
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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:
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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:
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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:
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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:
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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.
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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: 2029-01-11
Sent to Facility:
Sent to Provost: 2024-01-16
Sent to Legal:
Completed:
Requester Name: Catherine McCarroll
Document 1:
Document 2:
Document 3:
Comment: Sent partially executed agreement to facility. 1/17/2024
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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
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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: 2022-02-22
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
Sent email 7/06/23
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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:
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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) –
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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:
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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
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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
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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:
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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:
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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:
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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: 2022-02-01
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
No response sent another email 6/08/23
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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:
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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:
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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.
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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:
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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;
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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:
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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:
Comment:
sent email 6/08/23- Received address delivery error.
Phone: 770-442-0727
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Northeast Georgia Medical Center
Department of Physical Therapy, OT
Samantha Nanartowicz
Phone: 770-219-6287
Educatonal Services Dept.
Gainesville GA 30501
Agency Email: mellypt@hotmail.com
Expiration Date: 2025-05-05
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-21
Requester Name: Carla Huggins
Document 1: Final Expires May2022 ..NE GA MED CENTERpdf
Document 2: Northeast Georgia Amendment
Document 3:
Comment: Northeast Georiga Medical Center acquisition of Habersham
Medical center- finalizes on July 1, 2023
Copy ptclinicaleducation@gsu.edu
sent partially executed agreement on 3-14-2022
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Northeast Health District
BFLCNHP
Emily Eisenman
Phone: 706-583-2870
220 Research Drive
Athens GA 30605
Agency Email: emily.eisenman@dph.ga.gov
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-15
Sent to Provost: 2024-02-20
Sent to Legal:
Completed:
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
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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:
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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: 2025-08-31
Sent to Facility: 2017-11-28
Sent to Provost: 2017-12-05
Sent to Legal:
Completed: 2022-08-16
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Northside Hospital, Inc.
Department of Nutrition
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: Jessica Todd
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.
Current expires 3/18/24
Clinical
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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: 2023-10-27
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
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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
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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
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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:
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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:
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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.
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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.
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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: 2023-06-08
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: Please copy chuggins@gsu.edu
Updated renewal request Resent request to facility 6/08/2023
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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:
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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:
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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:
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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:
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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:
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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: 2024-02-09
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:
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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:
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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:
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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:
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Peds Care, PC
BFLCNHP
Jennifer Hosford
Phone: 706-278-6628
1993 Shields Road
Dalton GA 30720
Agency Email: amandamascote@pedscare.com
Expiration Date: 2026-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-27
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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: 2023-03-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
No response sent another email 6/08/23
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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:
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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:
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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:
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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:
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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: 2024-03-20
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, Select Medical
Please copy ptclinicaleducation@gsu.edu
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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.
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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: 2028-08-31
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.
Redmond Park dba AdventHealth Redmond
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Rehab Associates
Department of Physical Therapy
Roxanne St Martin
Phone: 334-272-8255
207 Interstate Park Drive
Montgomery AL 36106
Agency Email: https://www.rehab-associates.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: Covered by Physiotherapy Corporation
affiliated with Select Medical
Please cc ptclinicaleducation@gsu.edu
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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: Carla Huggins
Document 1:
Document 2:
Document 3:
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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
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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: 2024-01-30
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
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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: 2022-3-25
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
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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: 2022-05-12
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:
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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:
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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: 2022-06-15
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:
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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.
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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:
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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
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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
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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
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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: 2026-12-31
Sent to Facility:
Sent to Provost: 2024-03-05
Sent to Legal:
Completed: 2024-03-25
Requester Name: Lisa Williams
Document 1: Roswell OBGYN
Document 2:
Document 3:
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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.
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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:
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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
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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
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St. Josephs/Candler
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
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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.
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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.
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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:
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Shepherd Center, Inc.
Department of Nutrition
John McDaniel
Phone: 404-350-7340
2020 Peachtree Road, NW
Atlanta GA 30309
Agency Email: glenn_prescott@shepherd.org
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-12
Requester Name: Jessica Johnson
Document 1: view
Document 2: Exp Dec 2023 shepherd center exp 2023
Document 3:
Comment: Can you let me know if Nutrition would be covered through the
original contract? I am asking because the amendment did not
include nutrition in the section that specified the departments
that are included under the College of Nursing and Health
Professions.Please include Physical Therapy and Occupational
Therapy
clinical
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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.
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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.
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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:
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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.
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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: 2022-11-30
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please copy Masiki Williamson on communication at
ptclinicaleducation@gsu.edu. Thank you.
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Snellville Pediatrics, PC
School of Nursing
Shaleacia Shipman
Phone: 678-775-1501
1700 Tree Lane Road Suite 110
Snellville GA 30078
Agency Email: sshipman@snellvillepeds.com
Expiration Date: 2026-03-31
Sent to Facility: 2020-03-27
Sent to Provost: 2020-05-13
Sent to Legal:
Completed: 2023-08-24
Requester Name: Lisa Williams
Document 1: ExpMar2023 SnellvillePeds_Final pdf
Document 2:
Document 3:
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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:
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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:
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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
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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:
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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:
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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: 2026-09-29
Sent to Facility: 2016-12-13
Sent to Provost:
Sent to Legal:
Completed: 2023-10-13
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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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:
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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:
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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:
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Therapy Management Corporation, Inc.
Department of Physical Therapy
Lynsey Vanstory
Phone: 352-601-7096
8477 S. Suncoast Boulevard
Homosassa FL 34446
Agency Email: campusrelations@therapymgmt.com
Expiration Date: 2023-05-31
Sent to Facility: 2024-02-05
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Exp May 2020 therapy mgmt
Document 2: Final Exp May 2023 ...125114pdf
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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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.
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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
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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
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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:
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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: 2024-01-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu on communication
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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.
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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:
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University Health Systems, Inc.
Department of Physical Therapy
Chip Vowell
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
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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: 2026-04-30
Sent to Facility: 2019-07-01
Sent to Provost:
Sent to Legal: 2019-06-10
Completed: 2023-05-08
Requester Name: Carla Huggins
Document 1: Final Expires November 2022
Document 2:
Document 3:
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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
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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:
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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
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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
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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: 06/30/2023 auto renews
Sent to Facility: 2021-06-17
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:
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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:
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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.
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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:
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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:
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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.
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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: 2025-06-01
Sent to Facility: 2019-05-30
Sent to Provost: 2019-04-17
Sent to Legal: 2019-02-18
Completed: 2022-05-12
Requester Name: Jennifer Nelson
Document 1: WellstarHealthSystems_Final ExpJune2022
Document 2: WellstarAddendumsALL Programs
Document 3: Wellstar-addendum-2017.pdf
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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:
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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.
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Archbold Memorial Hospital, Inc.
Department of Physical 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: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Covers:Archbold Grady, Archbold Mitchell, Archbold Living
Thomasville, Archbold Living Camilla, Archbold Living Pelham,
Archbold Living Cairo); Archbold Foundation, Inc.; and
Archbold Medical Group
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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:
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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
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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:
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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
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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
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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:
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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:
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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:
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CVS Caremark/Minute Clinic, LLC
School of Nursing
Amy Waggoner
Phone: 401-770-3425
One CVS Drive 100SVD
Woonsocket RI 02895
Agency Email: amy.waggoner@cvshealth.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.
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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.
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Bremen Family Health & Wellness Center
School of Nursing
Lori Hudson
Phone: 770-537-5555
509 Alabama Avenue
Bremen GA 30110
Agency Email: bfhw@live.com
Expiration Date: 2025-10-31
Sent to Facility: 2017-03-17
Sent to Provost:
Sent to Legal:
Completed: 2023-01-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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
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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:
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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:
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Tender Ones Therapy Services, Inc. - OT
Department of Occupational Therapy
Marion Viar
Phone: 770-904-6009
2089 Teron Trace Suite 120
Dacula Ga 30019
Agency Email: therapy@tenderones.com
Expiration Date: 2026-01-31
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:
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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:
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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:
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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:
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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.
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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:
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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:
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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.
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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:
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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:
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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:
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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
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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:
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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:
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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
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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
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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
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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:
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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
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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: 2022-06-15
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:
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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:
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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:
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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
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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
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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:
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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: 2025-08-14
Sent to Facility: 2017-04-21
Sent to Provost: 2017-09-13
Sent to Legal:
Completed: 2025-08-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement
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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
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Pediatric Health Center of Conyers
BFLCNHP
Latricia Rose
Phone: 706-615-7858
2213 Exchange Place - Suite A
Conyers GA 30013
Agency Email: latriciarose@gmail.com
Expiration Date: 2026-06-30
Sent to Facility: 2022-04-21
Sent to Provost: 2019-07-02
Sent to Legal:
Completed: 2023-07-10
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.
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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
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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:
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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
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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.
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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:
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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: 2026-07-31
Sent to Facility: 2020-09-02
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Please cc Shana Finks sfinks@gsu.edu
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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:
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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:
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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: 2025-09-30
Sent to Facility: 2017-12-07
Sent to Provost:
Sent to Legal:
Completed: 2023-02-21
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Encompass Health Rehab Hospital of Arlington
Department of Occupational Therapy
Julie Clement
Phone: 817-419-4205
3200 Matlock Rd
Arlington TX 76015
Agency Email: Julie.clement@encompasshealth.com
Expiration Date: 2026-01-16
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-01
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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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:
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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
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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:
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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
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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:
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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
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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
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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.
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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
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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:
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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
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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
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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
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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: 2020-11-03
Sent to Provost: 2012-08-15
Sent to Legal:
Completed: 2012-08-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Koredjian
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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.
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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:
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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
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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:
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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:
|
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HighPoint Family Practice
School of Nursing
Wendy Parrish
Phone: 678-583-8388
886 Hampton Road
McDonough GA 30253
Agency Email: walton12@me.com
Expiration Date: 2026-09-30
Sent to Facility: 2019-12-18
Sent to Provost:
Sent to Legal:
Completed: 2023-10-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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.
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Psychiatric Consultants of Atlanta, PC
BFLCNHP
Katherine Kalachik
Phone: 770-234-0981
900 Hammond Drive Suite 525
Sandy Springs GA 30328
Agency Email: K.Kalachik@pcatl.com
Expiration Date: 2025-09-30
Sent to Facility: 2019-09-25
Sent to Provost: 2019-10-01
Sent to Legal:
Completed: 2022-10-19
Requester Name: Lisa Williams
Document 1: Final Expires Sept 2022
Document 2:
Document 3:
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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:
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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:
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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:
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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:
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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:
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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:
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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.
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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
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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
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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:
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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:
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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.
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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
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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:
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Swift Medical Group
BFLCNHP
Felix Amoa-Bonsu
Phone: 770-824-4343
6053 Jonesboro Road
Morrow GA 30260
Agency Email: docbonsu@swifturgentcare.com
Expiration Date: 2024-08-31
Sent to Facility: 2012-12-10
Sent to Provost: 2012-12-14
Sent to Legal:
Completed: 2023-08-07
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Covers:
South Atlanta Urgent Care Clinic - 5185 Old National
Highway, College Park, Ga 30349 and
Swift Health Medical Group at 6053 Jonesboro Road, Morrow,
Ga 30260
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Jefferson Pediatrics
BFLewis College
Dana Irwin
Phone: 706-367-1010
2610 US Hwy 129 N.
Jefferson GA 30549
Agency Email: dsirwin1973@yahoo.com
Expiration Date: 2026-05-31
Sent to Facility: 2012-12-19
Sent to Provost:
Sent to Legal:
Completed: 2023-06-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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: 2025-11-10
Sent to Facility: 2019-09-13
Sent to Provost: 2019-10-01
Sent to Legal:
Completed: 2023-04-10
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
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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:
|
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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:
|
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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:
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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:
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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:
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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:
|
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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:
|
| |
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|
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.
|
| |
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|
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:
|
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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: 2022-01-19
Sent to Provost: 2019-02-06
Sent to Legal:
Completed: 201-02-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
|
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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:
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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
|
| |
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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:
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Bethesda Community Clinic
BFLCNHP
Melissa Belfield
Phone: 678-880-9654
117 Mountain Brook Drive Suite 100
Canton GA 30115
Agency Email: director@bcccherokee.com
Expiration Date: 2026-07-31
Sent to Facility: 2020-08-10
Sent to Provost: 2020-08-13
Sent to Legal:
Completed: 2023-06-27
Requester Name: Lisa Williams
Document 1: ExpJul2023 BethesdaCommClinic_Aug2020 - signed
Document 2:
Document 3:
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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
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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:
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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:
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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:
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Perimeter Pediatric Clinic
BFLCNHP
Jane Wu
Phone: 770-458-3383
3020 Mercer university Drive Suite 100
Atlanta GA 30341
Agency Email: perimeterpediatrics@gmail.com
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: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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:
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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:
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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:
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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
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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:
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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:
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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
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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
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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: 2026-05-31
Sent to Facility: 2018-03-12
Sent to Provost:
Sent to Legal:
Completed: 2023-06-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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:
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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:
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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:
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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.
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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:
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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:
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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
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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: 2023-07-28
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Jennifer Nelson
Document 1: exp dec 2022 ...4122245.pdf
Document 2:
Document 3:
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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:
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Cedar Creek Pediatrics, PC
BFCNHP
Jack Rogers, Jr.
Phone: 678-901-0717
114 Plantation Avenue
Cedartown GA 30125-2370
Agency Email: office@cedarcreekpediatrics.com
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-13
Sent to Provost: 2013-06-03
Sent to Legal:
Completed: 2021-07-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Email delivery error 3-13-24
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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
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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: 2022-07-19
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:
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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
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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:
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MedLink Georgia, Inc.
BFLCNHP
Mohogany Jones
Phone: 706-367-4455
2748 Winder Highway
Jefferson GA 30549
Agency Email: mjones2@medlinkga.org
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost: 2021-12-09
Sent to Legal:
Completed: 2022-01-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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:
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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.
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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:
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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
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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:
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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:
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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.
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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:
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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
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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:
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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:
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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:
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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:
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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:
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Ascension St. Vincents Birmingham
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: 2023-07-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Name change
|
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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:
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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.
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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:
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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.
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Covington Womens Health Specialists, LLC
BFLCNHP
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:
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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:
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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:
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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.
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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.
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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:
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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: 2026-04-30
Sent to Facility: 2020-05-12
Sent to Provost: 2020-05-13
Sent to Legal:
Completed: 2023-03-15
Requester Name: Lisa Williams
Document 1: ExpApril2023 DahlonegaPedsAdol pdf
Document 2:
Document 3:
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Loganville Pediatrics and Adolescent Care Associates
BFLCNHP
Ann Tullis
Phone: 770-466-6112
3815 Harrison Road
Loganville GA 30052
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:
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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: 2023-05-02
Requester Name: Lisa Williams
Document 1: Final Expires October 2022
Document 2:
Document 3:
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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:
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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:
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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:
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Northside Pediatrics and Adolescent Medicine, PC
School of Nursing
Vicki Tittle
Phone: 404-256-2688 ext 140
1140 Hammond Drive Suite E 5250
Atlanta GA 30328
Agency Email: vt@nspeds.org
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:
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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:
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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
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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
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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: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-23
Requester Name: Karen McWaters
Document 1: exp apr 2023 ...6132234 pdf
Document 2:
Document 3:
Comment: Include J. Esha McTizic in final copy of agreement.
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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:
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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: 2025-07-31
Sent to Facility: 2016-11-09
Sent to Provost: 2016-11-10
Sent to Legal:
Completed: 2022-08-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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: 2026-12-31
Sent to Facility: 2023-11-09
Sent to Provost: 2024-02-15
Sent to Legal:
Completed:
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.
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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
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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:
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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
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| |
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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:
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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:
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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.
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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: 2025-07-31
Sent to Facility: 2020-02-18
Sent to Provost:
Sent to Legal:
Completed: 2023-3-28
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: This MOU has expired :( If we have to start all over, I
apologize!
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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
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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:
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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:
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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
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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:
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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:
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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
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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:
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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:
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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
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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:
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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:
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TMB Medical
BFCNHP
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: 2024-03-13
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:
|
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|
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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:
|
| |
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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:
|
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Spelman College
BFLCNHP
Dana Lloyd
Phone: 404-270-5250
McVicar Hall 350 Spelman Lane
Atlanta GA 30314
Agency Email: DLloyd@spelman.edu
Expiration Date: 2025-07-31
Sent to Facility: 2020-04-24
Sent to Provost:
Sent to Legal:
Completed: 2022-09-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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: 2021-06-15
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.
No response. Resent email 6/08/2023
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Incremedical Management, Inc.
Department of Occupational 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: 2024-04-10
Sent to Provost: 2019-10-31
Sent to Legal:
Completed: 2021-08-04
Requester Name: Karen McWaters
Document 1: Exp Dec 2022 doc03522320191101130958
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu>
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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:
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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:
|
| |
|
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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:
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| |
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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:
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Med South Associates, PC
School of Nursing
Yudelky Bentley
Phone: 770-996-9400
483 Upper Riverdale Road
Riverdale GA 30274
Agency Email: medsouthassociates@yahoo.com
Expiration Date: 2026-11-30
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed: 2024-02-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: additioanl address: frontdesk121@yahoo.com
Med South Associates, PC mailed again 12/06/2023
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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:
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| |
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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
|
| |
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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.
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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: 2026-08-31
Sent to Facility: 2017-01-10
Sent to Provost: 2017-01-11
Sent to Legal:
Completed: 2023-10-06
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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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:
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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:
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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:
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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
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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: 2021-11-18
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
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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
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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.
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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:
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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
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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:
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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: 2025-11-30
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:
Comment: Covers multiple locations:
FYZICAL® Therapy and Balance Centers listed as FYZICAL
Sprayberry.
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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: 2022-01-19
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:
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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:
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Hughston Clinic
Department of Physical Therapy
Debbie Woodstock
Phone: 706-494-3128
6298 Veterans Parkway Ste. 9
Columbus GA 31909
Agency Email: dwoodstock@hughston.com
Expiration Date: 2027-08-29
Sent to Facility: 2020-04-14
Sent to Provost:
Sent to Legal: 2024-02-21
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sent edits to facility 2/06/2024
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)
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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
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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:
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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
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Childrens Healthcare of Atlanta, Inc.
Department of Nutrition
Amanda Remillard
Phone: 404-785-1261
1575 Northeast Expressway
Atlanta GA 30329
Agency Email: amanda.remillard@choa.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-30
Requester Name: Jessica Todd
Document 1: ExpJuly2023 CHOA BOR July2023 pdf
Document 2: ExpJuly2023 CHOA GSU July2023
Document 3:
Comment: Clinical
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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
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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:
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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.
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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: 2021-11-18
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
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Exclusive Womens Healthcare
BFLCNHP
Jaliwa Hall
Phone: 678-817-6991
155 Carnegie Place Suite 203
Fayetteville GA 30214
Agency Email: drsonyika@bellsouth.net
Expiration Date: 2026-08-31
Sent to Facility: 2018-01-09
Sent to Provost: 2018-01-12
Sent to Legal:
Completed: 2023-11-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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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:
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Van Meter Pediatric Endocrinology
School of Nursing
Tamiko Burgess
Phone: 678-961-2100
1800 Howell Mill Road, NW Suite 475
Atlanta GA 30318
Agency Email: TBurgess@atlantadiabetes.com
Expiration Date: 2026-04-30
Sent to Facility: 2020-03-10
Sent to Provost: 2020-04-22
Sent to Legal:
Completed: 2023-05-18
Requester Name: Lisa Williams
Document 1: ExpApr2023 VanMeterPedsEndo_Apr2020 - signed
Document 2:
Document 3:
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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:
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Atlanta Pelvic & Orthopedic Rehabilitation Center
Department of Physical Therapy
Olabisi Brown
Phone: 404-935-9000
2900 Chamblee Tucker Road Bldg 3 - Suite 200
Atlanta GA 30341
Agency Email: O_brown@atlrehabcenter.com
Expiration Date: 2026-09-30
Sent to Facility: 2019-11-14
Sent to Provost: 2020-01-07
Sent to Legal:
Completed: 2023-08-24
Requester Name: Carla Huggins
Document 1: exp may 2023 ...113209.pdf
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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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: 2026-05-31
Sent to Facility: 2020-08-25
Sent to Provost: 2023-03-30
Sent to Legal: 2020-06-03
Completed: 2023-04-12
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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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:
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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:
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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: 2024-06-30
Sent to Facility:
Sent to Provost: 2024-04-09
Sent to Legal:
Completed: 2023-07-21
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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Integrity Rehab and Home Health
Department of Occupational Therapy
Leah Venard
Phone: 254-699-3933
5302 Janelle Dr.
Kileen Tx 76549
Agency Email: lvenard@integrityrehab.net
Expiration Date:
Sent to Facility: 2023-10-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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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:
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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:
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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: 2023-11-28
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Northeast Georgia Physicians Group_02_17-21
Document 2:
Document 3:
Comment: sent partially exec agreement to facility Includes Toccoa
/Clinical Medical Associates now known
a/s NGPG Toccoa Clinic.
Sent agreement to Joi for approval 11/27/23
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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: 2026-10-31
Sent to Facility: 2020-02-25
Sent to Provost: 2020-02-27
Sent to Legal: 2020-02-04
Completed: 2023-11-07
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
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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:
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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
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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:
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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:
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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
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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:
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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:
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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.
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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:
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Memorial Hermann Health System - PT and OT
Department of Physical Therapy
Victoria Zergarrundo
Phone: 713-704-2100
6411 Fannin Ground Floor, Jones Pavilion
Houston TX 77030
Agency Email: Victoria.Zegarrundo@memorialhermann.org
Expiration Date: 2022-07-31
Sent to Facility: 2024-03-25
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:
Comment: Please copy ptclinicaleducation@gsu.edu
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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:
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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.
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Friends of Disabled Adults and Children, too! inc.
Department of Occupational Therapy
David Carroll
Phone: 770-491-9014- ext 124
4900 Lewis Rd
Tucker Ga 30083
Agency Email: davidcarroll@fodac.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda,
I know we have had 2 types of MOUs in the past. One for
hospitals and traditional OT sites and one for Non-profit
community sites. I would like this MOU to be with the non-
profit community sites. Let me know if you have questions
about this.
Carolyn
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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: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-07-15
Requester Name: Jessica Todd
Document 1: ExpJuly2023 PeaPodNutritionLactation_Apr2020 - signed
Document 2:
Document 3:
Comment: Nonclinical
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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
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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:
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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
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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:
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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
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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
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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: 2023-10-10
Sent to Provost:
Sent to Legal:
Completed: 2020-11-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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
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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:
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Georgia Department of Corrections
School of Nursing
Christy Szabo
Phone: 478-445-5973
P. O. Box 278 2271 Vinson Hwy
Hardwick GA 31034
Agency Email: PCD-HSCRO@dcor.state.ga.us
Expiration Date: 2023-06-30
Sent to Facility: 2020-08-10
Sent to Provost: 2020-07-06
Sent to Legal: 2020-06-15
Completed: 2022-02-29
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.
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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:
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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
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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
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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:
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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:
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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:
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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:
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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:
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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
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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:
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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: 2022-01-27
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:
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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:
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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:
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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:
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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:
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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:
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Wingard Urgent Care & Wellness
BFLCNHP
Ray Bennett
Phone: 770-692-7575
1325 Commerce Drive Suite 200
Peachtree City GA 30269
Agency Email: wingardmed@gmail.com
Expiration Date: 2026-12-31
Sent to Facility: 2014-09-10
Sent to Provost: 2014-09-16
Sent to Legal:
Completed: 2023-01-25
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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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:
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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.
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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:
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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: 2024-03-25
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: klawrence@stmarysathens.org email address is no longer valid 3-
25-2024
7/16/20 updated COI requested from GSU Risk Mgmt
Please copy ptclinicaleducation@gsu.edu
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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: 2022-03-17
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
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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
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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.
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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
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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: 2021-11-18
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
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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
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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
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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: 2025-8-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-26
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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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:
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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: 2023-03-21
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:
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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:
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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.
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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
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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: 2026-10-11
Sent to Facility:
Sent to Provost: 2016-10-25
Sent to Legal:
Completed: 2023-10-12
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
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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:
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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.
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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:
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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: 2021-06-17
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
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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.
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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.
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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:
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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:
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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:
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Atlanta Community Food Bank
Department of Nutrition
Kristen Barwick
Phone: 678-933-0924
732 Joseph E. Lowery Blvd., NW
Atlanta GA 30318
Agency Email: kristen.barwick@acfb.org
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Jessica Todd
Document 1: Atlanta Community Food Bank_02-05-21
Document 2:
Document 3:
Comment: Nonclinical
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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
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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
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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).
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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
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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:
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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: 2022-06-15
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
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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
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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:
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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:
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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
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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:
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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:
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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
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U.S. 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: 2025-03-18
Sent to Facility: 2024-01-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: khix@usph.com new contact for U.S Physical Therapy (formerly
Advance Rehabilitation and Physical Therapy 1-24-2024
Please copy ptclinicaleducation@gsu.edu
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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
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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:
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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
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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
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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
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Lets Talk Therapy LLC
Department of Physical Therapy and Department of Occupational 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: 2023-03-24
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2020-02-11
Requester Name: Carla Huggins
Document 1: exp feb 2023 ...213165229pdf
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
Resent email 7/10/2023
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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
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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.
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Georgia State University Student Counseling and Health Centers
Health Informatics
Mikyta Daugherty
Phone: 404-413-1640
P.O. Box 3961
Atlanta GA 30302-3961
Agency Email: mdaugherty5@gsu.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Tamara Melton
Document 1:
Document 2:
Document 3:
Comment: Non-clinical agreement. we do no not require and agreement
with other GSU Offices/Departments.
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MHM Correctional Services, Inc
School of Nursing
Teffany Dowdy
Phone: 7037494600
1593 Spring Hill Road Suite 600
Vienna VA 22182
Agency Email: tdowdy@mhm-services.com
Expiration Date: 2021-07-31
Sent to Facility: 2018-06-26
Sent to Provost: 2018-10-10
Sent to Legal:
Completed: 2018-10-17
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 6/26/18 MOU emailed.
7/26/18 Template fr by clinic, sent to legal
8/16/18 Legal ok all changes, to facility for signature
10/17/18 Complete. All parties have final copies
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Kenmar Family Practice
School of Nursing
Sue Ellen Sutton
Phone: 770-590-0585
880 Canton Rd Suite 300
Marietta GA 30060
Agency Email: wesnell@kenmar.fdn.com
Expiration Date: 2018-09-30
Sent to Facility: 2015-09-22
Sent to Provost: 2015-11-10
Sent to Legal:
Completed: 2015-11-11
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Atlanta Family Physicians
School of Nursing
Keecha Smith
Phone: 404-968-8269
3424 Flat Shoals Road
Decatur Ga 30034
Agency Email: ksmith@afphysicians.com
Expiration Date: 2022-10-31
Sent to Facility: 2019-09-25
Sent to Provost: 2019-10-17
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Exp Oct 2022 doc03472120191023101841
Document 2:
Document 3:
Comment: Please renew.
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Northside Family Medicine and Urgent Care
School of Nursing
Lisa Hall
Phone: 770-509-1025
1121 Johnson Ferry Road Suite 100
Marietta GA 30068
Agency Email: none@none.com
Expiration Date: 2017-12-31
Sent to Facility: 2014-12-17
Sent to Provost: 2014-12-22
Sent to Legal:
Completed: 2015-01-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/6/2018 - This is a Northside Hospital affiliated clinic.
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Cardiovascular Clinic of North Georgia
School of Nursing
Salman Ashfaq
Phone: 678-430-3110
1287 Sims Street
Gainesville GA 30501
Agency Email: salman@cvcng.com
Expiration Date: 2017-12-31
Sent to Facility: 2014-12-18
Sent to Provost: 2015-01-14
Sent to Legal:
Completed: 2015-01-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: T
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The Nutrition Addiction
Department of Nutrition
megan kober
Phone: 5639403732
626 Dekalb Ave SE 1001
atlanta ga 30312
Agency Email: megan@thenutritionaddiction.com
Expiration Date: 2022-06-30
Sent to Facility: 2022-06-09
Sent to Provost: 2019-11-06
Sent to Legal:
Completed: 2019-11-07
Requester Name: Jessica Todd
Document 1: Exp June2022 doc...140346
Document 2:
Document 3:
Comment: non clinical
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East Georgia Internal Medicine and Pediatrics
School of Nursing
Michelle Woods
Phone: 912-486-1500
1449 Brampton Avenue
Statesboro GA 30458
Agency Email: michelle.woods@eastgeorgiaregional.com
Expiration Date: 2018-11-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Live Athletics - Movement in Medicine
Department of Physical Therapy
Zach Ray
Phone: (805) 910-9913
258 Lombard Street
Thousand Oaks CA 91360
Agency Email: info@liveathletics.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-09
Sent to Provost: 2015-01-09
Sent to Legal:
Completed: 2015-01-16
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Fully executed MOU mailed to Agency 1/20.
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Sabrina Harrison, MD, PC
School of Nursing
Sabrina Harrison
Phone: 770-670-6145
3535 Peachtree Road, NE 520-623
Atlanta GA 30326
Agency Email: swhmig@gmail.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-09
Sent to Provost: 2015-01-20
Sent to Legal:
Completed: 2015-01-27
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: 2/13/2018 - This site and preceptor no longer accept
students for clinical rotations. LYW
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Dekalb Pediatric Center
BFLCNHP
Bruce Linston
Phone: 404-508-1177
350 Winn Way
Decatur GA 30030
Agency Email: info@dekalbpeds.net
Expiration Date: 2021-12-31
Sent to Facility: 2021-11-18
Sent to Provost: 2018-01-23
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Yamato Orthopedic and Spinal Rehabilitation
Department of Physical Therapy
Brad Goldman
Phone: 561-477-6929
9101 Lakeridge Blvd Suite 23
Boca Raton FL 33496
Agency Email: yosr@aol.com
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:
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Grady Memorial Hospital Corporation d/b/a Grady Health System-Nursing
School of Nursing
Crystal Minnis
Phone: 404-616-5866
80 Jesse Hill Jr. Drive, SE
Atlanta GA 30303
Agency Email: cminnis@gmh.edu
Expiration Date: 2022-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1: Grady Nursing Only expires Nov2019
Document 2: Grady Nursing Assoc and Higher Exp Nov7 2019
Document 3: Final Exp Aug 2022 ...135947pdf
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Sy Med LLC
School of Nursing
Syamala Erramilli
Phone: 770-466-5902
2926 Mountain Industrial Blvd.
Tucker GA 30084
Agency Email: symedllc@gmail.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-12
Sent to Provost: 2015-01-20
Sent to Legal:
Completed: 2015-02-10
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
Comment: Fully executed MOU emailed and mailed to Agency 2/12/15.
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Landmark Hospital
Byrdine F Lewis School of Nursing and Health Professions
Marie Saylor
Phone: 215-237-4197
775 Sunset Drive
Athens GA 30606
Agency Email: masaylor@landmarkhospitals.com
Expiration Date: 2026-06-30
Sent to Facility: 2020-04-30
Sent to Provost: 2020-05-18
Sent to Legal:
Completed: 2023-06-06
Requester Name: Lisa Williams
Document 1: ExpJune2023 LandmarkHospital_Apr2020
Document 2:
Document 3:
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Essential Therapy Services
Department of Occupational Therapy
Irma Alvarado
Phone: (678) 679-1261
4640 Martin Rd Suite 300
Cumming Ga 30041
Agency Email: ialvarado@essentialts.com
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost: 2024-01-02
Sent to Legal:
Completed: 2024-01-11
Requester Name: Karen McWaters
Document 1: exp july 2022 ...213165410pdf
Document 2:
Document 3:
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North Point Physical Therapy
Department of Physical Therapy
Joel Eaby
Phone: 678-400-0300
2500 Old Alabama Road
Roswell GA 30076
Agency Email: joel@northpointtherapy.com
Expiration Date: 2017-12-31
Sent to Facility: 2020-01-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Public Health Informatics Institute
Health Informatics
Sarah Gilbert
Phone: 404.592.1404
325 Swanton Way
Decatur GA 30030
Agency Email: sgilbert@phii.org
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-14
Sent to Provost: 2015-01-22
Sent to Legal:
Completed: 2015-02-19
Requester Name: Tamara Melton
Document 1:
Document 2:
Document 3:
Comment: Non-Clinical
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Locust Grove Family Medicine and Reliance Family Care
BFL College of Nursing and Health Professionals
Donna Pearson
Phone: 678-610-6649
3778 Highway 42
Locust Grove GA 30248
Agency Email: none
Expiration Date: 2023-07-31
Sent to Facility: 2020-08-04
Sent to Provost: 2020-08-26
Sent to Legal:
Completed: 2020-09-01
Requester Name: Lisa Williams
Document 1: ExpJuly2023 LocustGroveFamMedRelianceFamCare forProvost - signed
Document 2:
Document 3:
Comment: Wanda, please send to me and I will fax to the practice.
Thank. LYW
Other site is: Reliance Family Care, 345 Huntington Place
Ct., McDonough, GA 30253
Lisa agreed to fax on 6/13/23
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Performance Nutrition
Department of Nutrition
Diane King
Phone: 404-354-0008
328 Rhodes House Court
Suwanee GA 30024
Agency Email: performnutrition@bellsouth.net
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-14
Sent to Provost: 2015-01-23
Sent to Legal:
Completed: 2015-02-10
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical MOU.
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Truven Health Analytics
Health Informatics
Marci Bennafield
Phone: (404) 812-4505
3490 Piedmont Road NE Suite 1110
Atlanta GA 30305
Agency Email: marci.bennafield@truvenhealth.com
Expiration Date: 2018-04-30
Sent to Facility: 2015-01-14
Sent to Provost: 2015-02-26
Sent to Legal:
Completed: 2015-03-09
Requester Name: Tamara Melton
Document 1:
Document 2:
Document 3:
Comment: Marci Bennafield Cell Phone: (404) 433-7974 She often works
out of the office. Non-clinical MOU emailed.
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Pediatric Endocrine Associates, PC
Department of Nutrition
Carrie Kay
Phone: (404)255-0015 ext 143
1100 Lake Hearn Dr NE, Suite 350
Atlanta GA 30342
Agency Email: casher@pedendo.com
Expiration Date: 2017-12-31
Sent to Facility: 2015-01-14
Sent to Provost: 2015-02-05
Sent to Legal:
Completed: 2015-02-19
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Decatur Hand and Physical Therapy Specialists
Department of Physical Therapy
Rachele Branson
Phone: 404-296-8511
141 Suite A Sams St Suite A
Decatur GA 30030
Agency Email: rbranson@usphclinic.com
Expiration Date: 2024-03-31
Sent to Facility: 2024-01-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Decatur Hand and Physical Therapy Specialists
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
Agency no longer has a north location.
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Emory Bariatrics
Department of Nutrition
Victoria Delgado
Phone: 404-778-3603
550 Peachtree St NE Meidcal Office Tower
Atlanta GA 30308
Agency Email: victoria.delgado@emoryhealthcare.org
Expiration Date: 2020-12-31
Sent to Facility: 2017-04-21
Sent to Provost: 2017-08-17
Sent to Legal:
Completed: 2017-11-16
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.
@LEGAL
complete
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Wellness Family Clinic
BFLCNHP
Tina Okey
Phone: 678-213-3137
2317 Austell Road, SW
Marietta GA 30008
Agency Email: wellnessfamily@comcast.net
Expiration Date: 2021-12-31
Sent to Facility: 2021-11-18
Sent to Provost: 2018-01-04
Sent to Legal:
Completed: 2018-01-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: renewal emailed however email address is underliverable
12/7 - sent renewal to cokereke29@gmail.com. LYW
complete
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Concentra Health Services, Inc. dba Concentra Medical Services
Department of Occupational Therapy
Laurie Osielski
Phone: 262-814-2503
2455 N 124th St.
Brookfield, WI 53005
Agency Email: laurie_osielski@concentra.com
Expiration Date: 2025-3-30
Sent to Facility: 2016-05-11
Sent to Provost:
Sent to Legal:
Completed: 2022-01-25
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Amend Renewal emailed. Sent to Legal for review and
approval 5/17. Sent to Legal for Provost signature 3/22/17.
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The Medical Center d/b/a Midtown Medical Center
Department of Physical Therapy & Occupational Therapy
Susan Kuakowski
Phone: 706-494-2040
100 First Court
Columbus GA 31906
Agency Email: Susan.Kuakowski@columbusregional.com
Expiration Date:
Sent to Facility: 2016-01-12
Sent to Provost: 2016-01-21
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Under the Columbus Regional Health Umbrella. Sent to Site
for signature 1/28/16.
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Camp Twin Lakes
Perimeter College Department of Nursing
Jamie Ekstrom
Phone: 770-867-6123 ext. 228
210 Broad St. Unit 5
Winder Georgia 30680
Agency Email: jamie@camptwinlakes.org
Expiration Date: 2020-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Brandi Pinckney
Document 1:
Document 2:
Document 3:
Comment: We would like to use this facility for summer clinical,
starting June 8th. Thank you.
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OBGYN & Midwife Associates
BFLCNHP
Sherry Sandridge
Phone: 404-349-2112
2719 Felton Drive Suite A
Atlanta GA 30344
Agency Email: Sandridge.Sherry@gmail.com
Expiration Date: 2024-12-31
Sent to Facility: 2015-01-26
Sent to Provost: 2015-01-27
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 1/19/21 - contract sent to correct email address. LYW
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The Freedman Group
Department of Occupational Therapy
Peggy Freedman
Phone: 770-541-7401
1950 Spectrum Circle Suite 125
Marietta GA 30067
Agency Email: mail@thefreedmangroup.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Jydes Family Clinic
BFLCNHP
Bekah Tollison
Phone: 678-804-9944
2089 Teron Trace Suite 225
Dacula GA 30019
Agency Email: bekah@jydesfamilyclinic.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:
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Outside in Nutrition LLC
Department of Nutrition
Jennifer Seay
Phone: 678-736-6357
1130 N Carter Rd
Decatur Ga 30030
Agency Email: jennifer@outsideinnutrition.com
Expiration Date: 2020-11-30
Sent to Facility: 2017-10-24
Sent to Provost: 2017-10-27
Sent to Legal:
Completed: 2017-11-01
Requester Name: jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical Agreement
complete
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Academy of Nutrition and Dietetics
Department of Nutrition
Mary Pat Raimondi
Phone: 800.877.0877 X 6007
1120 Connecticut Ave, NW, 460
Washington DC 20036
Agency Email: mraimondi@eatright.org
Expiration Date: 2018-01-31
Sent to Facility: 2015-01-30
Sent to Provost: 2015-02-03
Sent to Legal:
Completed: 2015-02-10
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Cobb Internal Medicine
BFLCNHP
Jonea Wright
Phone: 678-797-9800
2655 Dallas Hwy, SW Suite 340
Marietta GA 30064
Agency Email: administrator@cobbinternalmedicine.com
Expiration Date: 2022-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Exp May 2022 doc03471420191023101603
Document 2:
Document 3:
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Georgia Mountains Health Services
School of Nursing
Suzanne Young
Phone: 706-529-3643
218 North Frederick Street
Dalton GA 30721
Agency Email: syoung@gamtnhealth.org
Expiration Date: 2018-01-31
Sent to Facility: 2015-01-28
Sent to Provost: 2015-02-02
Sent to Legal:
Completed: 2015-02-19
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
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Lawrenceville Family Practice, PC
School of Nursing
Paige Stover
Phone: 770-661-0335
1730 Lawrenceville Suwanee Road
Lawrenceville GA 30043
Agency Email: pstover@lfpractice.com
Expiration Date: 2018-12-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 2/11 - please renew. LYW
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SunSouth Medical Center
BFLCNHP
Anthony Labady, Jr
Phone: 770-892-1543
1467 John Robert Drive Suite B
Morrow GA 30260
Agency Email: sunsouthmedical@gmail.com
Expiration Date: 2020-08-31
Sent to Facility: 2023-02-02
Sent to Provost: 2017-08-22
Sent to Legal:
Completed: 2017-08-28
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Douglas Womens Center
BFLCNHP
Pat Holloway
Phone: 770-941-8662
880 Crestmark Drive Suite 200
Lithia Springs GA 30122
Agency Email: pholloway@douglaswomenscenter.com
Expiration Date: 2021-06-30
Sent to Facility: 2021-05-06
Sent to Provost:
Sent to Legal:
Completed: 2018-08-28
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Lifestance Health Inc
BFLCNHP
Shawndrea Martin
Phone: 470-795-7695
833 Campbell Hill Street Suite 350
Marietta GA 30060
Agency Email: Shawndrea.Marti@lifestance.com
Expiration Date: 2025-12-31
Sent to Facility: 2018-04-04
Sent to Provost: 2018-04-14
Sent to Legal:
Completed: 2022-02-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Southern Behavioral CARE
School of Nursing
Olufemi Taiwo
Phone: 678-610-7100
222 Arrowhead Blvd
Jonesboro GA 30236
Agency Email: sbhc222@bellsouth.net
Expiration Date: 2021-01-31
Sent to Facility: 2017-11-03
Sent to Provost: 2018-01-23
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Global Franchise Group
Department of Nutrition
Hillard Creath
Phone: 404-242-4990
4685 Fredrick Dr. SW
Atlanta Georgia 30336
Agency Email: hcreath@gfgmanagement.com
Expiration Date: 2018-03-31
Sent to Facility: 2015-04-20
Sent to Provost: 2015-04-30
Sent to Legal:
Completed: 2015-05-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical. renewal sent2/28/18
email used CustomerService@gfgmanagement.com
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Cobb & Douglas Public Health
School of Nursing
Catherine Smythe
Phone: 770-514-2351
1650 County Services Parkway
Marietta GA 30008
Agency Email: catherine.smythe@dph.ga.gov
Expiration Date: 2021-01-31
Sent to Facility: 2021-02-04
Sent to Provost: 2018-01-25
Sent to Legal:
Completed: 2018-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Vickery Pediatrics, LLC
School of Nursing
Tracy Bertini
Phone: 678-990-2501
410 Peachtree Pkwy Suite 4260
Cumming GA 30041
Agency Email: tbertini@vickerypeds.com
Expiration Date: 2018-01-31
Sent to Facility: 2015-02-06
Sent to Provost: 2015-02-06
Sent to Legal:
Completed: 2015-02-19
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
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Clarkston Community Health Center
Williams
Saeed Raees
Phone: 404-512-9675
3700 Market Street Suite E
Clarkston GA 30021
Agency Email: saeedr@clarkstonhealth.org
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-24
Sent to Provost: 2019-04-29
Sent to Legal:
Completed: 2019-05-09
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Please copy Dr. Gulshan Harjee, gharjee@comcast.net,on the
MOU email. LYW
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Medstar Georgetown University Hospital
Department of Occupational Therapy
Michelle Voyer
Phone: 202 444 3690
3800 RESERVOIR RD NW
WASHINGTON DC 20007
Agency Email: Michelle.I.Voyer@gunet.georgetown.edu
Expiration Date:
Sent to Facility: 2019-02-26
Sent to Provost: 2019-05-08
Sent to Legal: 2024-03-05
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Edits sent to facility 3/05/2024
facility wants to use their agreement. Sent to legal.
2/26/19 Edits from legal sent to facility
Send signed contract to Johanna Murphy
JCZ2@gunet.georgetown.edu
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Atlanta Behavioral Care
BFLCNHP
Jeffrey Klopper
Phone: 770-319-6000
3188 Atlanta Road, SE
Smyrna GA 30080
Agency Email: klopperabc@gmail.com
Expiration Date: 2027-03-31
Sent to Facility: 2024-03-12
Sent to Provost: 2015-02-11
Sent to Legal:
Completed: 2016-04-16
Requester Name: Lisa Williams
Document 1: view
Document 2: Atlanta Behavioral Care
Document 3:
Comment:
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Dunwoody Pediatrics
School of Nursing
Angela W. Gordon
Phone: 770-394-2358
1428 Dunwoody Village Parkway
Dunwoody GA 30338
Agency Email: agordon@dunwoodypediatrics.com
Expiration Date: 2018-01-31
Sent to Facility: 2015-02-10
Sent to Provost: 2015-02-24
Sent to Legal:
Completed: 2015-03-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
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SC Internal Medicine Associates & Rehabilitation, LLC
School of Nursing
Jannie Davis
Phone: 803-454-1097
1 Wellness Boulevard Suite 200
Irmo SC 29063
Agency Email: jdavis@scinternalmedicine.com
Expiration Date: 2019-04-30
Sent to Facility: 2016-05-03
Sent to Provost: 2016-05-04
Sent to Legal:
Completed: 2016-05-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta Center for Dermatologic Disease, PC
School of Nursing
Wendy Mark
Phone: 770-844-1902
1265 Upper Hembree Road Suite 100
Roswell GA 30076
Agency Email: wmark@atlcenterforderm.com
Expiration Date: 2018-02-28
Sent to Facility: 2015-02-18
Sent to Provost: 2015-02-20
Sent to Legal:
Completed: 2015-03-09
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: renewal sent
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Michael Vaughn MD
BFLCNHP
Michael Vaughn
Phone: 770-674-1540
2150 Peachford Road Suite V
Atlanta GA 30338
Agency Email: MrVmd53@bellsouth.net
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-19
Sent to Provost: 2018-02-21
Sent to Legal:
Completed: 2018-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Michael Vaughn MD
School of Nursing
Michael Vaughn
Phone: 770-674-1540
2150 Peachford Road
Atlanta GA 30338
Agency Email: MrVmd53@bellsouth.net
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kellen Company
Department of Nutrition
Sylvia Poulos
Phone: 678-303-2953
1100 Johnson Ferry Rd ste 300
Atlanta Georgia 30342
Agency Email: spoulos@kellencompany.com
Expiration Date: 2019-05-31
Sent to Facility: 2016-05-26
Sent to Provost: 2016-06-21
Sent to Legal:
Completed: 2016-06-29
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical.
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Mary Hall Freedom House
School of Nursing
Yvonne Cole
Phone: 770-642-5500
8995 Roswell Road
Sandy Springs GA 30350
Agency Email: Yvonne.cole@MHFH.org
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Cobb County Senior Services
Department of Nutrition
Jobcy Alexander
Phone: 770-528-5396
1150 powder springs street
Marietta GA 30064
Agency Email: jobcy.alexander@cobbcounty.org
Expiration Date: 2022-02-28
Sent to Facility: 2018-12-19
Sent to Provost: 2019-01-25
Sent to Legal:
Completed: 2019-01-30
Requester Name: Jessica Todd
Document 1: CobbCoSrSvcs 2015
Document 2: CobbCoSrSvcs 2017
Document 3: Final Expires Feb 2022
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Park Central Family Practice
BFLCNHP
Jessica Able
Phone: 770-981-2008
4367 New Snapfinger Woods Drive
Decatur GA 30035
Agency Email: jessica@parkcentral1.net
Expiration Date: 2022-02-28
Sent to Facility: 2022-02-02
Sent to Provost: 2019-01-18
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: Park Central Fam Med Orig 2015
Document 2: ParkCentral renewal 2017
Document 3: Final Expires Feb 2022
Comment:
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Toccoa Family Medicine, Inc.
School of Nursing
Kathy Fritchman
Phone: 706-886-0088
843 Falls Road
Toccoa GA 30577
Agency Email: drfritchman@yahoo.com
Expiration Date:
Sent to Facility: 2018-02-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl McManus
Document 1:
Document 2:
Document 3:
Comment: new mou sent out
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Georgia Pediatric Cardiology, P. C.
BFLCNHP
Freddie Crowell
Phone: 678-289-1988
1045 Southcrest Drive Suite 220
Stockbridge Georgia 30281
Agency Email: freddiecrowell7444@yahoo.com
Expiration Date: 2022-03-31
Sent to Facility: 2023-03-08
Sent to Provost: 2019-05-23
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment:
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North Georgia Hand Therapy, LLC
Department of Occupational Therapy
Amy Wallace
Phone: 770 889 0885
2920 Ronald Reagan Blvd Suite 110
Cumming GA 30041
Agency Email: ngahandtherapy@gmail.com
Expiration Date: 2026-07-31
Sent to Facility: 2019-11-22
Sent to Provost: 2019-12-09
Sent to Legal:
Completed: 2023-08-24
Requester Name: Shana Finks
Document 1: Final Expires feb2023 ...125045pdf
Document 2:
Document 3:
Comment: Please request to owner of business that the contract name is
updated to reflect both North GA Hand Therapy AND Equine in
Motion as one business.
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Skyland Trail
Department of Nutrition
Isabel Alvarez
Phone: 607-379-1295
1961 North Druid Hills Rd NE
Atlanta Georgia 30329
Agency Email: IAlvarez@skylandtrail.org
Expiration Date: 2027-01-31
Sent to Facility: 2024-01-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1: Skyland Trail Jan 2021
Document 2:
Document 3:
Comment: Nonclinical
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Houston Hospitals, Inc. d/b/a Houston Healthcare - APRN Students
School of Nursing
Marilyn Peterson
Phone: 478-542-7815
1601 Watson Boulevard
Warner Robins GA 31093
Agency Email: mpeterson@hhc.org
Expiration Date: 2020-12-31
Sent to Facility: 2018-02-02
Sent to Provost: 2018-02-15
Sent to Legal:
Completed: 2018-02-21
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Powder Springs Clinic
School of Nursing
Mahaveer Vakharia
Phone: 770-943-8701
4171 Marietta Street #500
Powder Springs GA 30127
Agency Email: docvak@bellsouth.net
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-03
Sent to Provost: 2018-02-21
Sent to Legal:
Completed: 2018-03-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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The Piedmont School Inc.
Department of Occupational Therapy
Catherine Trapani
Phone: 404 382 3200
4484 Peachtree
Atl Ga 30319
Agency Email: catherine.trapani@tpsoa.org
Expiration Date: 2021-12-31
Sent to Facility: 2017-11-15
Sent to Provost: 2018-01-09
Sent to Legal:
Completed: 2018-01-09
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: complete
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Johns Creek Pediatrics
School of Nursing
Maria Steadman
Phone: 770-814-1160
4395 Johns Creek Parkway Suite 150
Suwanee GA 30024
Agency Email: officemanager@johnscreekpediatrics.net
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:
Comment: 4/12 - The site does not wish to renew contract. LYW
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District 1 Unit 1, Northwest Georgia Public Health
School of Nursing
Donna Stanford
Phone: 770-443-7881 x107
451 Jimmy Campbell Parkway
Dallas GA 30132
Agency Email: Donna.Stanford@dph.ga.gov
Expiration Date: 2023-06-16
Sent to Facility: 2016-05-09
Sent to Provost: 2016-05-26
Sent to Legal:
Completed: 2016-06-17
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Serves Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon,
Haralson, Paulding, Polk &Walker Health Departments.
This is a one-year agreement to be renewed automatically
unless terminated by either party.
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Druid Hills Physical Therapy
Department of Physical Therapy
Avi Zinn
Phone: 470-427-3840
2800 North Druid Hills Road
Atlanta GA 30329
Agency Email: avi@druidhillspt.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2022-05-03
Requester Name: Carla Huggins
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Amina Medical Consultants PC
School of Nursing
Amina Hassanali
Phone: 404-929-1402
2840 Northeast Expressway Suite 116
Atlanta GA 30345
Agency Email: centromedicohispano1@gmail.com
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-26
Sent to Provost: 2017-10-19
Sent to Legal:
Completed: 2017-11-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Fayette County Public Schools
Department of Nutrition
Kokeeta Wilder
Phone: (770) 460-3990 Ext. 480
205 LaFayette Avenue
Fayetteville Georgia 30214
Agency Email: wilder.kokeeta@mail.fcboe.org
Expiration Date: 2021-03-31
Sent to Facility: 2018-02-28
Sent to Provost: 2018-03-06
Sent to Legal:
Completed: 2018-03-23
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical
complete
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Janet Campbell Smith, LLC
School of Nursing
Janet Smith
Phone: 404-327-1095
5237 Hayden Farms Drive
Powder Springs GA 30127
Agency Email: jansmith0525@gmail.com
Expiration Date: 2018-03-31
Sent to Facility: 2015-03-26
Sent to Provost: 2015-03-30
Sent to Legal:
Completed: 2015-04-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
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Internal Medicine Group of Griffin
School of Nursing
Lisa Skipper
Phone: 770-227-1587
231 Graefe Street
Griffin GA 30224
Agency Email: lisaskipper.img@comcast.net
Expiration Date: 2018-03-31
Sent to Facility: 2015-03-26
Sent to Provost: 2015-08-03
Sent to Legal:
Completed: 2015-08-13
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Dr. Speeds Global Breast Health and Wellness
School of Nursing
Sharon Brissett
Phone: 678-210-2846
1364 Wellbrook Circle
Atlanta GA 30012
Agency Email: sharonbrissett.dd@gmail.com
Expiration Date: 2018-03-31
Sent to Facility: 2015-04-13
Sent to Provost: 2015-05-27
Sent to Legal:
Completed: 2015-06-09
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Syed W. Rizvi d/b/a Primary Health Care PC
School of Nursing
Cynthia Mudgett
Phone: 770-992-0002
434 Shallowford Road Suite B4A
Marietta GA 30062
Agency Email: phcpc@att.net
Expiration Date: 2018-03-31
Sent to Facility: 2015-03-27
Sent to Provost: 2015-03-31
Sent to Legal:
Completed: 2015-04-09
Requester Name: Sheryl McManus
Document 1: view
Document 2:
Document 3:
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Life Care Centers of America, Inc.
Byrdine F. Lewis College of Nursing and Health Professions
Jennifer Beavers
Phone: (423) 473-5871
3001 Keith Street NW
Cleveland TN 37312
Agency Email: Jennifer_Beavers@lcca.com
Expiration Date: Auto-renew
Sent to Facility: 2016-04-19
Sent to Provost: 2016-05-06
Sent to Legal:
Completed: 2016-05-06
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: This is a one-year agreement that will be renewed
automatically for successive one-year terms unless
terminated. However on 5/17/22 Beavers, Jennifer Jennifer_Beavers@lcca.com requested a renewal though it is noted as a contract that auto renews. She is the person the renewal should be coordinated with. Please make sure renewal covers all programs in Lewis College. Shana Finks
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Northlake Pediatric Associates
School of Nursing
Delores Taliaferro
Phone: 770-498-9355
1805 Parke Plaza Circle SW
Stone Mountain Georgia 30087
Agency Email: norlkped@bellsouth.net
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:
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Children at Play, LLC
Department of Occupational Therapy
Samantha Hyali
Phone: 443-745-0926
1610 West Street Suite 207
Annapolis MD 21401
Agency Email: samantha@childrenatplayot.com
Expiration Date: 2023-04-30
Sent to Facility: 2024-03-05
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1: ExpApr2023 ChildrenatPlay_forProvost - signed
Document 2:
Document 3:
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Atlanta Pediatric Nutrition
Department of Nutrition
Bailey Koch
Phone: 404-543-3897
993-D Johnson Ferry Road, NE 440
Atlanta Ga 30324
Agency Email: bailey@atlantapediatricnutrition.com
Expiration Date: 2024-03-31
Sent to Facility: 2017-10-17
Sent to Provost: 2017-10-18
Sent to Legal:
Completed: 2021-4-16
Requester Name: Jessica Todd
Document 1: Atlanta Pediatric Nutrition
Document 2:
Document 3:
Comment: Nonclinical
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Peachtree Womens Clinic
BFLCNHP
Jennifer deGraaf
Phone: 404-255-8022
5780 Peachtree Dunwoody Road Suite 200
Atlanta GA 30342
Agency Email: jdegraaf@awhg.org
Expiration Date: 2026-01-31
Sent to Facility: 2020-02-04
Sent to Provost: 2020-03-04
Sent to Legal:
Completed: 2023-02-21
Requester Name: Lisa Williams
Document 1: xp jan 2023 ...6132029 pdf
Document 2:
Document 3:
Comment: Also Offices in Alpharetta and Cumming.
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Tallahassee Memorial Healthcare
School of Nursing
Christina Izquierdo
Phone: 850-431-5786
Center for Healthcare Careers
Tallahassee FL 32308
Agency Email: Cristina.Izquierdo@tmh.org
Expiration Date: 2017-07-31
Sent to Facility: 2017-06-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Renewal emailed.
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Strong Healthcare and Wellness
School of Nursing
Derrick Foreman
Phone: 404-835-2891
1711 Washington Avenue
Atlanta GA 30344
Agency Email: shw@stronghealthcare.net
Expiration Date: 2018-03-31
Sent to Facility: 2015-04-22
Sent to Provost: 2015-07-28
Sent to Legal:
Completed: 2015-07-31
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Post Acute Physicians of Georgia (Eastside Neuro Specialists)
School of Nursing
Altovise Vertus
Phone: 770-674-4888
2121 Fountain Drive Suite D
Snellville GA 30078
Agency Email: alvotise.vertus@eastsideneurorehab.com
Expiration Date: 2018-09-30
Sent to Facility: 2015-10-08
Sent to Provost: 2015-10-15
Sent to Legal:
Completed: 2015-10-20
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Dr. Cynthia Chambless
School of Nursing
Cynthia Chambless
Phone: 478-475-1413
6501 Peake Road Suite 200
Macon GA 31210
Agency Email: chamblessom@hotmail.com
Expiration Date: 2018-04-30
Sent to Facility: 2015-04-29
Sent to Provost: 2015-04-30
Sent to Legal:
Completed: 2015-05-27
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Women for Womens Health
School of Nursing
Jessica Alligood
Phone: 478-742-6738
1062 Forsyth Street Suite 2A
Macon GA 31201
Agency Email: jessicaalligood@gmail.com
Expiration Date: 2018-04-30
Sent to Facility: 2015-04-29
Sent to Provost: 2015-05-18
Sent to Legal:
Completed: 2015-05-27
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Clayton County Board of Health
School of Nursing
Tawana Phillips-Evans
Phone: 678-610-7199
1117 Battlecreek Road
Jonesboro GA 30236
Agency Email: tawana.evans-phillips@dph.ga.gov
Expiration Date: 2018-05-31
Sent to Facility: 2015-04-05
Sent to Provost: 2015-06-23
Sent to Legal:
Completed: 2015-06-29
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Lexington Coutnty Health Services District
School of Nursing
Patricia Perez
Phone: 803-791-2000
2720 Sunset Blvd
West Columbia SC 29169
Agency Email: psperez@lexhealth.org
Expiration Date: 2018-07-31
Sent to Facility: 2015-05-06
Sent to Provost: 2015-08-06
Sent to Legal:
Completed: 2015-09-01
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Herron Pediatrics
BFLCNHP
Linda Clark
Phone: 404-446-1480
1 Baltmore Place NW Suite 350
Atlanta GA 30308
Agency Email: lclark@merindaherronmdpc.com
Expiration Date: 2024-09-30
Sent to Facility: 2018-05-02
Sent to Provost: 2018-05-18
Sent to Legal:
Completed: 2021-09-27
Requester Name: Lisa Williams
Document 1: Herron Pediatrics
Document 2:
Document 3:
Comment:
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Eat Well Georgia LLC
Department of Nutrition
Jacy Pitts
Phone: 404-520-1270
4045 Orchard road Building 200, Suite 230
Smyrna Ga 30080
Agency Email: eatwellgeorgia@gmail.com
Expiration Date: 2025552541
Sent to Facility: 2017-11-28
Sent to Provost: 2018-02-07
Sent to Legal:
Completed: 2022-02-03
Requester Name: jessica Todd
Document 1:
Document 2:
Document 3:
Comment: clinical agreement
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Brother Bills Helping Hand
School of Nursing
Suzanne Griffin
Phone: 214-638-2196
3906 N. Westmoreland
Dallas TX 75212
Agency Email: sgriffin@bbhh.org
Expiration Date: 2018-04-30
Sent to Facility: 2015-05-12
Sent to Provost: 2015-05-15
Sent to Legal:
Completed: 2015-07-08
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Purely Planted
Department of Nutrition
Nicobella Dandrea-Russert
Phone: 6097925231
100 6th Street NE Unit 1715
Atlanta GA 30308
Agency Email: nichole@purelyplanted.com
Expiration Date: 2025-03-31
Sent to Facility: 2019-01-11
Sent to Provost: 2019-01-22
Sent to Legal:
Completed: 2022-05-13
Requester Name: Jessica Todd
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Non-clinical agreement. Renewal Needed.
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The Family Health Centers of Georgia, Inc.
Lewis College
Candace Brown
Phone: 404-756-6883
868 York Avenue, SW
Atlanta GA 30310
Agency Email: cbrown@fhcga.org
Expiration Date: 2018-10-31
Sent to Facility: 2019-06-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please send new contract. 6/19 contract sent
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Cardinal Health
Department of Nutrition
Karen Kawolics
Phone: 330-963-6998 x3518
1909 Summit Commerce Park
Twinsburg OH 44087
Agency Email: karen.kawolics@cardinalhealth.com
Expiration Date:
Sent to Facility: 2018-06-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: To cover the Georgia Location, please send PDF and Word
Doc for review. 6/27/18 emailed.
7/3/18 Kawolics responded she will fw to her legal dept.
11/8/18 received termination letter from facility.
attached.
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First Georgia Physician Group
Lisa Beckham
Phone: 678-593-9016
101 Yorktown Drive Suite 100
Fayetteville Georgia 30214
Agency Email: lbeckham@firstgaphysiciangroup.com
Expiration Date: 2021-06-30
Sent to Facility: 2021-05-12
Sent to Provost: 2018-06-28
Sent to Legal:
Completed: 2018-07-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: ALSO COVERS FIRTS PHYSICIANS GROUP PEDS OF YORKTOWN IN
Fayette, GA
6/28/18 to legal
7/17/18 received from Legal
7/19/18 emailed complete to all parties
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Isis Womens Health Care
School of Nursing
Sharon Daniel
Phone: 770-521-2229
3925 Johns Creek Court Suite D
Suwanee GA 30024
Agency Email: sdaniel@isisobgyn.com
Expiration Date: 2018-04-30
Sent to Facility: 2015-05-14
Sent to Provost: 2015-05-27
Sent to Legal:
Completed: 2015-06-09
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Guilford Immediate Care
BFLCNHP
Christie Connor
Phone: 770-532-0800
1250 Jesse Jewell Parkway #300
Gainesville GA 30501
Agency Email: christiec@gic30.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:
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Interactiv Childrens Therapy Services
Department of Occupational Therapy
Tara Mulvany
Phone: (770) 683-0250
2959 hwy 154
newman ga 30265
Agency Email: tmulvany@ictsonline.com
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost: 2024-01-17
Sent to Legal:
Completed: 2024-02-08
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Sent MOU to facility on 12/12/23 - need updated by 1/15/24 -
Karen McWaters
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Abundant Life Healthcare
BFLCNHP
Tiffany Gomez
Phone: 678-206-5709
601A Professional Drive Suite 370
Lawrenceville GA 30046
Agency Email: alhobgyn12@gmail.com
Expiration Date: 2025-08-31
Sent to Facility: 2015-06-10
Sent to Provost: 2015-06-16
Sent to Legal:
Completed: 2015-06-29
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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The Little Clinic of Georgia, LLC
School of Nursing
Eileen Myers
Phone: 615-796-3161
2620 Elm Hill Pike
Nashville, TN 37214
Agency Email: kadams@thelittleclinic.com
Expiration Date: 2018-04-30
Sent to Facility: 2015-06-10
Sent to Provost: 2015-07-24
Sent to Legal:
Completed: 2015-08-06
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
Comment: Cathleen McKnight notified us to their wish to terminate
this agreement after completion of current rotation on
1.11.2017.
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GI Care for Kids
School of Nursing
Myra Atkinson
Phone: 404-257-0799
993D Johnson Ferry Road NE
Atlanta GA 30342
Agency Email: matkinson@gicareforkids.com
Expiration Date: 2019-09-30
Sent to Facility: 2019-10-06
Sent to Provost: 2019-10-06
Sent to Legal:
Completed: 2016-10-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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University of West Georgia Health Services
BFLCNHP
Kelly Smith
Phone: 678-839-6452
1601 Maple Street
Carrollton GA 30118
Agency Email: kellys@westga.edu
Expiration Date: 2024-06-30
Sent to Facility: 2018-06-01
Sent to Provost: 2018-10-02
Sent to Legal:
Completed: 2021-06-29
Requester Name: Lisa Williams
Document 1: University of West Georgia Health Services
Document 2:
Document 3:
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Ideal Therapy LLC
Department of Occupational Therapy
Corlette Luke-Cambridge
Phone: 404 994 0027
290 Highway 314 Suite B
Fayetteville Ga 30214
Agency Email: ccambridge@idealtherapy.net
Expiration Date: 2024-08-31
Sent to Facility: 2020-09-02
Sent to Provost:
Sent to Legal:
Completed: 2021-08-04
Requester Name: Shana Finks
Document 1: Ideal Therapy LLC
Document 2:
Document 3:
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EmergiNet
School of Nursing
Neil Trabel
Phone: 770-994-9326
235 Peachtree Street, NE North Tower, Suite 2100
Atlanta GA 30303
Agency Email: ntrabel@emerginet.com
Expiration Date:
Sent to Facility: 2015-06-24
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: MOU emailed.
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University of West Georgia
Byrdine F Lewis School of Nursing and Health Professions
Karen Duke
Phone: 678-839-2450
1601 Maple Street
Carrollton GA 30118
Agency Email: kduke@westga.edu
Expiration Date: 2022-09-30
Sent to Facility: 2019-09-13
Sent to Provost: 2019-09-19
Sent to Legal: 2019-09-16
Completed: 2019-10-08
Requester Name: Lisa Williams
Document 1: Final Expires September 2022
Document 2:
Document 3:
Comment: 9/14/2022 - UWG as facility. LYW
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YouthCare Child and Adolescent Medicine
BFLCNHP
Gina Dawson
Phone: 478-923-3360
233 N. Houston Road Suite 140H
Warner Robins GA 31093-3023
Agency Email: Youthcare@youthcare.net
Expiration Date: 2025-10-31
Sent to Facility: 2018-06-01
Sent to Provost:
Sent to Legal:
Completed: 2023-12-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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K B Solutions and Behavioral Support Services, LLC
Byrdine F Lewis School of Nursing and Health Professions
Laquanda Spince
Phone: 470-878-1691
3200 N Henry Blvd Suite C
Stockbridge GA 30281
Agency Email: Kbsbonline@gmail.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kingsley E. Agbeyegbe, MD, PC
School of Nursing
Kwavi Agbeyegbe
Phone: 404-305-0004
1151 Cleveland Avenue Suite C
East Point GA 30344
Agency Email: kwavi@kwavi.com
Expiration Date: 2018-06-30
Sent to Facility: 2015-06-25
Sent to Provost: 2015-08-24
Sent to Legal:
Completed: 2015-09-02
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Physicians Immediate Med
School of Nursing
Nicole Burns
Phone: 770-476-3000
3551 Satellite Boulevard
Duluth GA 30096
Agency Email: nicole@pimclinic.com
Expiration Date: 2018-06-30
Sent to Facility: 2015-07-01
Sent to Provost: 2015-08-01
Sent to Legal:
Completed: 2015-08-06
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Camp Twinlakes
School of Nursing
Dan Matthews
Phone: 706-557-9070 Ext. 403
1391 Keecheefoonee Road
Rutledge GA 30663
Agency Email: dan@camptwinlakes.org
Expiration Date: 2020-04-30
Sent to Facility: 2017-01-27
Sent to Provost: 2017-04-06
Sent to Legal:
Completed: 2017-04-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Project Open Hand, Inc.
Health Informatics
Aleta McLean
Phone: 404-419-3313
181 armour Drive, NE
Atlanta GA 30324
Agency Email: amclean@projectopenhand.org
Expiration Date: 2018-06-30
Sent to Facility: 2015-07-01
Sent to Provost: 2015-07-08
Sent to Legal:
Completed: 2015-07-21
Requester Name: Melton Tamara
Document 1:
Document 2:
Document 3:
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Gynecology and Obstetrics of DeKalb, P.C.
BFLCNHP
Debra Bennington
Phone: 404-299-9307
2801 N. Decatur Road Suite 190
Decatur GA 30033
Agency Email: d.bennington@goodobgyn.com
Expiration Date: 2021-06-30
Sent to Facility: 2018-06-01
Sent to Provost: 2018-07-23
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Womens Specialty Care
School of Nursing
Pam Waters
Phone: 478-744-9683
682 Hemlock Street Suite D
Macon GA 31201
Agency Email: Pam.Waters@wscmacon.com
Expiration Date: 2019-02-28
Sent to Facility: 2016-02-22
Sent to Provost: 2016-04-26
Sent to Legal:
Completed: 2016-05-09
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Building Bridges Therapy Inc.
Department of Occupational Therapy
Marla Mann
Phone: 770-886-6204
1389 Webber Industrial Dr.
Cumming GA 30041
Agency Email: marla.mann@buildingbridgestherapy.com
Expiration Date: 2025-07-31
Sent to Facility: 2020-09-02
Sent to Provost: 2020-09-03
Sent to Legal:
Completed: 2022-08-08
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
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Cobb Womens Health PA
School of Nursing
Catharine Allen
Phone: 770-944-8660
1810 Mulkey Road Suite 102
Austell GA G30106
Agency Email: callen@cobbwomenshealth.com
Expiration Date: 2024-07-31
Sent to Facility: 2018-05-31
Sent to Provost: 2018-06-04
Sent to Legal:
Completed: 2021-07-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Humane Society of the United States
Department of Nutrition
Rebecca Portman
Phone: 404-357-3688
220 Kathryn Avenue
Decatur Ga 30030
Agency Email: rportman@humanesociety.org
Expiration Date: 2020-09-30
Sent to Facility: 2019-08-07
Sent to Provost: 2019-08-12
Sent to Legal:
Completed: 2019-08-29
Requester Name: Jessica Todd
Document 1: Humane Society of US FINAL
Document 2: Final Expires September 2020
Document 3:
Comment: 8/7/19 non clinical renewal initiated -Kelli
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Georgia Reproductive Specialists
School of Nursing
Sue Schneider
Phone: 404-843-2229
5445 Meridian Mark Road Suite 270
Atlanta GA 30342
Agency Email: sschneider@ivf.com
Expiration Date: 2018-07-30
Sent to Facility: 2018-06-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 6/1/18 Renewal letter emailed
6/5/18 Clinic in merger, cannot participate at this time,
per Sue Schneider.
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CSI Behavioral Company, LLC
School of Nursing
Vangela Hines
Phone: 478-304-1244
1528 Telfair Street
Dublin Georgia 31021
Agency Email: dublin_csi@yahoo.com
Expiration Date: 2018-07-31
Sent to Facility: 2015-08-07
Sent to Provost: 2015-08-12
Sent to Legal:
Completed: 2015-08-25
Requester Name: Traci Sims
Document 1: view
Document 2:
Document 3:
Comment: This request is for the NURS 7160 course for Sonya
Shinhoster.
Any questions contact Traci Sims - tsims8@gsu.edu
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Highland Rivers Community Service Board d/b/a Highland Rivers Health
School of Nursing
Jason Malone
Phone: 706-270-5008 ext 1124
1401 Applewood Drive Suite 5
Dalton GA 30720
Agency Email: jasonmalone@highlandrivers.org
Expiration Date: 2022-10-24
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 10/10 - Contract fwd to Caroline
1/10 - to Provost
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Rockdale County Public Schools
Department of Occupational Therapy
Michele Stephens
Phone: 770 761 1443
954 North Main Street
Conyers GA 30012
Agency Email: mstephens@rockdale.k12.ga.us
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost: 2024-01-17
Sent to Legal:
Completed: 2024-01-19
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Sent updated MOU on 12/12/23
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Premier Womens Specialists, PC
BFLCNHP
Jackie Boatwright
Phone: 404-296-1424
2675 North Decatur Road Suite 501
Decatur GA 30033
Agency Email: kdaus@yahoo.com
Expiration Date: 2024-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-06-23
Requester Name: Lisa Williams
Document 1: Premier Womens Specialists, PC
Document 2:
Document 3:
Comment:
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Champion Partners in Rehab
Department of Occupational Therapy
Bart Hyche
Phone: 256-214-0301
1514 Owens Street
Gadsden AL 35904
Agency Email: bhyche@championpartnersinrehab.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: Automatic renewal requested by facility. Thanks
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Lifeline Primary Care
BFLCNHP
Reema Sisodia
Phone: 770-559-3501
4025 Lawrenceville HWY NW Suite A
Lilburn GA 30047
Agency Email: LLPC.clinics@gmail.com
Expiration Date: 2024-08-31
Sent to Facility: 2018-07-16
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2021-09-02
Requester Name: Lisa Williams
Document 1: view
Document 2: Lifeline Primary Care
Document 3:
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Saint James Medical Center
School of Nursing
Bernard Orewa
Phone: 770-941-4012
5987 Mableton Pkwy SW
Mableton GA 30126
Agency Email: docorewa@hotmail.com
Expiration Date: 2018-08-31
Sent to Facility: 2015-09-09
Sent to Provost: 2015-09-16
Sent to Legal:
Completed: 2015-09-21
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Grupo Medico de Georgia
BFLCNHP
Eddy Lajara
Phone: 770-559-3555
5955 Jimmy Carter Boulevard
Norcross GA 30071
Agency Email: eddy@sugarhill-medical.com
Expiration Date: 2024-06-30
Sent to Facility: 2018-06-26
Sent to Provost: 2018-08-20
Sent to Legal:
Completed: 2021-05-13
Requester Name: Lisa Williams
Document 1: Grupo Medico de Georgia_exp_06-30-2024
Document 2:
Document 3:
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Medical Missions Outreach
Byrdine F Lewis School of Nursing and Health Professions
Kelly Edmondson
Phone: 410.391.7000
150 Oak Shores Drive
McDonough GA 30253
Agency Email: kelly@medical-outreach.com
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-15
Requester Name: Lisa Williams
Document 1: Medical Missions Outreach
Document 2:
Document 3:
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Gainesville Heartand Vascular Group, PC
School of Nursing
Sherry Whitfield
Phone: 770-534-9014
535 Jesse Jewell Parkway Suite C
Gainesville GA 30501
Agency Email: swhitfield@ghvg.net
Expiration Date: 2018-08-31
Sent to Facility: 2015-08-19
Sent to Provost: 2015-08-20
Sent to Legal:
Completed: 2015-08-25
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Achievement Therapies, LLC
Department of Occupational Therapy
Angelika Brocklehurst
Phone: 404-769-7584
114 New Street
Decatur Ga 30030
Agency Email: angelika.brocklehurst@gmail.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-10-04
Sent to Provost: 2016-10-11
Sent to Legal:
Completed: 2016-10-18
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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Wings of Dove Christian Academy
Perimeter College Department of Nursing
Sharon Boddie
Phone: 678-418-3209
6038 Covington Highway
Decatur Georgia 30035
Agency Email: info.woadprep@gmail.com
Expiration Date: 2021-12-31
Sent to Facility: 2017-12-17
Sent to Provost:
Sent to Legal:
Completed: 2018-09-14
Requester Name: Greta Baldwin Mason
Document 1: Final Expires December 2021
Document 2:
Document 3:
Comment: mou emailed
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Portal de Salud (Portal of Health)
School of Nursing
Olga Lucia Jimenez
Phone: 770-717-1517
PO BOX 921.605
Peachtree Corners GA 30010
Agency Email: info@portal-of-health.org
Expiration Date: 2018-08-31
Sent to Facility: 2018-09-06
Sent to Provost: 2018-10-11
Sent to Legal:
Completed: 2018-10-26
Requester Name: Lisa Williams
Document 1: view
Document 2: view
Document 3:
Comment: 9/6/18 MOU emailed.
The Medical Director is:
Flavia Mercado, M.D.
Medical Director
Clinical Operations
800-390-3180 ext 1217¶
Flavia E. Mercado
Inovalon, Inc
1559 Janmar Road
Snellville, GA 30078
(301) 809-4000 x1217
fmercado@inovalon.com
Portal de Salud is a health ministry currently
organizing as a Non-Profit Organization in the State of
Georgia. The Organization has established an office at
the Catholic Mission Our Lady of Americas in Lilburn,
Georgia to assist the parish’s 29,000 Hispanic/Latino
members.
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Provenance Rehabilitation
Department of Physical Therapy
Jenny Hunt
Phone: 678-819-8720
11975 Morris Road 310A
Alpharetta GA 30005
Agency Email: provenance.rehab@gmail.com
Expiration Date: 2020-10-31
Sent to Facility: 2020-05-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: re sent to facility 8/28/20
sent email 6/08/23
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Behavioral Counseling & Intervention Management, LLC.
School of Nursing
Bill Ward
Phone: (478) 494 2314
1000 Telfair Street
Dublin Georgia 31021
Agency Email: execenterprises@aol.com
Expiration Date: 2018-08-31
Sent to Facility: 2015-09-03
Sent to Provost: 2015-09-11
Sent to Legal:
Completed: 2015-09-17
Requester Name: Traci Sims
Document 1:
Document 2:
Document 3:
Comment: renewal sent 8/1/18
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Balance Fitness and Nutrition, LLC
Department of Nutrition
Jenny Askew
Phone: 757-869-9951
4555 Mansell Rd
Alpharetta Ga 30022
Agency Email: jenny@bfan.us
Expiration Date: 2018-08-31
Sent to Facility: 2015-09-03
Sent to Provost: 2015-09-22
Sent to Legal:
Completed: 2016-01-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: clinical agreement.
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My MenuPal
Department of Nutrition
Lesley Baradel
Phone: 404.664.4344
P.O. Box 422373
Atlanta Ga 30342
Agency Email: lesley@mymenupal.com
Expiration Date: 2018-08-31
Sent to Facility: 2015-09-09
Sent to Provost: 2015-09-09
Sent to Legal:
Completed: 2016-01-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement.
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Pediatric Orthopaedic Associates
School of Nursing
Lauren Kaeser
Phone: 404-446-3833
6 Executive Park Drive Suite 10
Atlanta Georgia 30329
Agency Email: lkaeser@mypedsortho.com
Expiration Date: 2019-05-31
Sent to Facility: 2016-05-27
Sent to Provost: 2016-06-03
Sent to Legal:
Completed: 2016-06-15
Requester Name: Regena Spratling
Document 1:
Document 2:
Document 3:
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Gwinnett Urgent and Family Care
BFLCNHP
E. Mariza Diab
Phone: 470-275-4911
4775 Jimmy Carter Blvd Suite 201
Norcorss GA 30093
Agency Email: mdiab@gucfp.com
Expiration Date: 2022-12-31
Sent to Facility: 2018-08-14
Sent to Provost: 2018-08-14
Sent to Legal:
Completed: 2021-12-17
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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SeeBaby
School of Nursing
Martha Mills
Phone: 404-223-9306
550 Peachtree Street Suite 1165
Atlanta, GA 30308
Agency Email: info@seebaby.org
Expiration Date: 2018-08-31
Sent to Facility: 2015-09-11
Sent to Provost: 2015-09-15
Sent to Legal:
Completed: 2015-10-08
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
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Camp Twin Lakes
Byrdine F Lewis School of Nursing and Health Professions
Paige Smith
Phone: 706-557-9070 ext 204
1391 Keencheefoonee Road
Rutledge Ga 30663
Agency Email: paige@camptwinlakes.org
Expiration Date:
Sent to Facility: 2017-07-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: This will be a great opportunity for all of our
departments!
MOU emailed 7/19/17
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Sunnyside Pediatrics LLC
BFLCNHP
Dev Patre
Phone: 770-233-4668
1661 W McIntosh Road
Griffin GA 30223
Agency Email: devpatre@yahoo.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:
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Georgia Highlands Medical Services, Inc.
School of Nursing
Tracie Webb
Phone: 470-297-1002
475 Tribble Gap Road
Cumming GA 30040
Agency Email: Tracie.Webb@ghms-inc.org>
Expiration Date: 2026-02-28
Sent to Facility: 2020-02-10
Sent to Provost: 2020-02-18
Sent to Legal:
Completed: 2023-04-17
Requester Name: Lisa Williams
Document 1: exp Jan 2023 Georgia Highlands Medical pdf
Document 2:
Document 3:
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Alkaline Wellness Center: Physical Therapy/Functional Medicine/Yoga/Pilates
Department of Physical Therapy
Connie Jeon
Phone: (678) 335-5566
6955 McGinnis Ferry Road Suite 112
Johns Creek GA 30097
Agency Email: connie@alkalinewellness.com
Expiration Date: 2021-09-30
Sent to Facility: 2021-06-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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The Kaufmann Clinic, Inc.
School of Nursing
Janet Grimmette
Phone: 404-881-9727
550 Peachtree Street, NE Suite 1700
Atlanta Georgia 30308
Agency Email: rsk920@aol.com
Expiration Date: 2022-04-30
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-21
Sent to Legal:
Completed: 2019-03-29
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: Covers both the Atlanta and Woodstock locations.
3/13/19 perrywes@charter.net undeliverable
3/13/19 updated email to rsk920@aol.com
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Heart and Vascular Care
School of Nursing
Lisa Glodis
Phone: 678-513-2273
1505 Northside Blvd. Suite 4000
Cumming GA 30041
Agency Email: lglodis@hvcmd.com
Expiration Date: 2018-10-31
Sent to Facility: 2018-07-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 7/16/18 Renewal emailed
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VITAS Healthcare Corporation
School of Nursing
Brenda Bloomer
Phone: 404-843-6511
1575 Northside Drive
Atlanta GA 30318
Agency Email: Brenda.Bloomer@vitas.com
Expiration Date: 2018-12-1(auto renew)
Sent to Facility: 2015-12-02
Sent to Provost: 2015-12-10
Sent to Legal:
Completed: 2015-12-10
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
Comment: Auto Renew- One Year Agreement
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Columbus Regional Healthcare System
Byrdine F Lewis College of Nursing and Health Professions
Susan Kulakowski
Phone: 706 494-2040
707 Center Street
Columbus Georgia 31901
Agency Email: Susan.Kulakowski@columbusregional.com
Expiration Date: 2018-12-31
Sent to Facility: 2018-10-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: SEE PIEDMONT HEALTHCARE, INC
Covers The Medical Center, Inc. dba Midtown Medical Center
and Hughston Hospital, Inc. dba Northside Medical Center
auto renews
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Douglas County School System
Department of Occupational Therapy
Rhonda Baldwin
Phone: 770-651-2324
4841 Bill Arp Road/Highway 5 Murray Educational Center
Douglasville Ga 30134
Agency Email: trudy.woodall@douglas.k12.ga.us
Expiration Date: 2027-01-31
Sent to Facility:
Sent to Provost: 2024-03-05
Sent to Legal:
Completed: 2024-03-06
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Calhoun Ob/Gyn Associates
School of Nursing
Kelly Mcfadden
Phone: 706-625-1275
170 Curtis Parkway Suite 1
Calhoun GA 30701
Agency Email: km@calhounobgyn.com
Expiration Date: 2018-09-30
Sent to Facility: 2015-10-06
Sent to Provost: 2015-10-09
Sent to Legal:
Completed: 2015-10-20
Requester Name: Beverly Roseberry
Document 1:
Document 2:
Document 3:
Comment: renewal sent 8/1/18
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Stone Mountain Family Medicine
BFLCNHP
Anita Virani
Phone: 404-296-8858
1183A S. Hairston Road
Stone Mountain GA 30088
Agency Email: anitav14@gmail.com
Expiration Date: 2020-10-31
Sent to Facility: 2020-09-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Robert E, Springer, III, MD, PC
School of Nursing
Chandra Cooper
Phone: 404-920-6201
50 Executive Park South Ne Suite 5012
Atlanta, GA 30329
Agency Email: gatravnurse@yahoo.com
Expiration Date: 2018-09-30
Sent to Facility: 2015-10-09
Sent to Provost: 2015-10-12
Sent to Legal:
Completed: 2015-10-12
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Clark Atlanta University Student Health Services
School of Nursing
Janet Singleton
Phone: 404-880-8286
223 James P. Brawley Dr. SW
Atlanta GA 30314
Agency Email: jsingleton@cau.edu
Expiration Date: 2018-09-30
Sent to Facility: 2015-10-09
Sent to Provost: 2015-11-13
Sent to Legal:
Completed: 2015-12-02
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Good Shepherd Clinic
BFLCNHP
Lisa Page
Phone: 770-968-1310
6392 Murphy Drive
Morrow GA 30260
Agency Email: lpage@goodshepherdclinic.org
Expiration Date: 2025-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-07-15
Sent to Legal:
Completed: 2022-05-19
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
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Community Rehabilitation Services, Inc.
Department of Occupational Therapy
Bernice Cash
Phone: 706- 278-4438
Integra Rehabilitation Suite 2
Dalton Ga 30721
Agency Email: bernicecash@integrarehab.org
Expiration Date: 2024-04-30
Sent to Facility: 2015-10-12
Sent to Provost: 2016-08-16
Sent to Legal:
Completed: 2016-08-24
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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Southeastern Psychological Associates
School of Nursing
Priscilla Faulkner
Phone: 678-712-6520
3155 Mill Street SE
Covington GA 30014
Agency Email: faulknerpsyd@gmail.com
Expiration Date: 2020-10-31
Sent to Facility: 2017-10-17
Sent to Provost: 2017-10-18
Sent to Legal:
Completed: 2017-10-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Sparks Christian Academy
School of Nursing
Dannetta Sparks
Phone: 770-808-0301
5949 Fairington Road
Lithonia GA 30038
Agency Email: drsparksd@bellsouth.net
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: MOU Completed.
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Crawford Family Medicine
School of Nursing
Freddy Neal Gaton
Phone: 478-836-2819
106 McCrary Avenue
Roberta GA 31078
Agency Email: Crawfordfm@pstel.net
Expiration Date: 2025-01-31
Sent to Facility: 2019-02-13
Sent to Provost: 2019-02-22
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Trinity Rehab Services
Department of Physical Therapy
Nick Hicks
Phone: 740-695-0069
72640 Fairpoint New Athens Road
St. Clairsville OH 43950
Agency Email: Nick.Hicks@TrinityRehabServices.com
Expiration Date: 2018-10-31
Sent to Facility: 2018-10-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Trinity Rehab Services now owns Cumming Nursing Center
(which may have been under Select Rehab formerly)
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Stepping Stone Pediatrics
School of Nursing
Tanya Wilcox
Phone: 770-515-9000
1770 Dennis Kemp Lane
Kennesaw GA 30152
Agency Email: tcwilcox@charter.net
Expiration Date: 2018-10-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: 2/11 - please renew. LYW
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TenderCare Clinic, Inc.
School of Nursing
Sharon Lester
Phone: 706-453-1201
803 South Main Street
Greensboro GA 30642
Agency Email: slester@tendercarega.org
Expiration Date: 2018-10-31
Sent to Facility: 2019-07-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Heritage Medical Associates, P.C.
School of Nursing
James Browne
Phone: (615) 284-2222
222 22nd Ave. N.
Nashville TN 37203
Agency Email: Jbrowne@heritagemedical.com
Expiration Date: 2019-04-30
Sent to Facility: 2016-04-19
Sent to Provost: 2016-04-22
Sent to Legal:
Completed: 2016-05-09
Requester Name: Katherine Evans
Document 1:
Document 2:
Document 3:
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Comprehensive OB/GYN Health Center Inc.
School of Nursing
Joanne Wilson
Phone: 912-877-2228
455 South Main Street Suite 202
Hinesville GA 31313
Agency Email: comprehensiveobgyn@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2015-10-21
Sent to Provost: 2015-10-23
Sent to Legal:
Completed: 2015-10-29
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Northside Primary Care, Inc.
School of Nursing
Aazrum Syed
Phone: 678-867-0904
11820 Northfall Lane Suite 1103
Alpharetta GA 30009
Agency Email: northsideprimarycare@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 2/11 - please renew. LYW
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Bulloch Pediatrics Group
School of Nursing
Kristen Hart
Phone: (912) 871-4847
1497 Fair Road Suite 200
Statesboro Georgia 30458
Agency Email: bullochpeds.officemanager@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2015-10-27
Sent to Provost: 2015-10-28
Sent to Legal:
Completed: 2016-03-01
Requester Name: Regena Spratling
Document 1:
Document 2:
Document 3:
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Ghosn Family Medicine
BFLCNHP
Lisa Waters
Phone: 706-265-8002
73 Prestige Lane Suite 103
Dawsonville GA 30534
Agency Email: managerghosn@gmail.com
Expiration Date: 2024-07-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed: 2021-07-09
Requester Name: Lisa Williams
Document 1: Ghosn Family Medicine
Document 2:
Document 3:
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Resurgens, LLC (DBA Resurgens Orthopaedics & Resurgens Rehabilitation
Department of Occupational Therapy
Greg March
Phone: 404-847-9999
5671 Peachtree Dunwoody Rd GA 30342 Suite 700
Atlanta GA 30342
Agency Email: marchgp@resurgens.com
Expiration Date: 2024-07-31
Sent to Facility: 2024-04-10
Sent to Provost:
Sent to Legal:
Completed: 2021-08-13
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Carla Huggins has requested that this agreement also cover
PT students.
Contract will be signed by Alex Bateman, CEO- send
contract to Greg March and he will forward to Alex.
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Bethesda Medical Group
School of Nursing
Patsy Driver
Phone: 770-328-6398
9280 Highway 5 Suite D
Douglasville GA 30134
Agency Email: driver.patsy@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2019-03-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/4 - please renew
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Mark L. Lipham, MD
School of Nursing
Ellen Lipham
Phone: 770-832-3935
105 Doctors Drive
Carrollton GA 30117
Agency Email: drlipham@bellsouth.net
Expiration Date: 2018-10-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 2/11 - please renew. LYW
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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
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MedNow Inc
School of Nursing
Lori McCallister
Phone: 706-275-4444
2709 Airport Roard Suite 101
Dalton GA 30721
Agency Email: Loritmednow@optilink.us
Expiration Date: 2020-09-30
Sent to Facility: 2017-09-06
Sent to Provost: 2017-09-13
Sent to Legal:
Completed: 2017-09-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: mou complete sent to all parties
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Resurgia Health Solutions
School of Nursing
Mark Bradshaw
Phone: 404-445-5304
1100 Peachtree Street NE Suite 200
Atlanta GA 30309
Agency Email: info@resurgia.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed: 2019-02-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Hospital Authority of Tift County d/b/a/ Tift Regional Medical Center
Department of Physical Therapy
Debra H. Davis
Phone: 229-353-6510
901 East 18th Street
Tifton GA 31735
Agency Email: Debra.Brown@tiftregional.com
Expiration Date: 2018-11-09
Sent to Facility: 2018-10-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Kids Can Occupational Therapy Services
Department of Occupational Therapy
Robbyn Laufer
Phone: 770-317-6755
4939 Lower Roswell Road Building C Suite 201
Marietta Ga 30068
Agency Email: rlaufer@kids-can.com
Expiration Date: 2026-12-31
Sent to Facility: 2023-12-12
Sent to Provost: 2024-01-03
Sent to Legal:
Completed: 2024-01-11
Requester Name: Karen McWaters
Document 1: Kids Can Occupational Therapy Services_exp_11-30-2023
Document 2:
Document 3:
Comment: Send MOU on 12/12/23
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Greater Athens Physicians INC.
School of Nursing
Linda Hueseman
Phone: 706-743-8183
774 Athens RD
Athens GA 30648
Agency Email: gheard@athensgapi.com
Expiration Date: 2019-02-28
Sent to Facility: 2016-02-26
Sent to Provost: 2016-02-26
Sent to Legal:
Completed: 2016-03-07
Requester Name: Eva Horne
Document 1:
Document 2:
Document 3:
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The Coca Cola Company
Department of Nutrition
Ansley Fowler
Phone: 4046155243
One coca cola plaza
atlanta ga 30313
Agency Email: anfowler@coca-cola.com
Expiration Date:
Sent to Facility: 2019-02-28
Sent to Provost: 2019-04-17
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: Non-clinical
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Love Eat Local
Department of Nutrition
Lindsay Saripkin
Phone: 999-999-9999
120 Wisteria Cir
Roswell GA 30076
Agency Email: lindsay.saripkin@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2015-11-06
Sent to Provost: 2015-11-10
Sent to Legal:
Completed: 2016-03-01
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical agreement.
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Dr Soos Pediatrics
School of Nursing
Katelyn Keith
Phone: 478-272-0203
102 Bowling Lane
Dublin GA 31021
Agency Email: katelyn@drsoos.net
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-04-27
Sent to Legal:
Completed: 2018-05-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Venture Physical Therapy
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: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-27
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Hillandale Internal Medicine, P.C.
School of Nursing
Audrey Tyler
Phone: 770-987-8400
5910 Hillandale Drive Suite 355
Lithonia GA 30058
Agency Email: hillandale.internalmedicine@yahoo.com
Expiration Date: 2018-10-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 2/8 - please renew
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Young Minds Psychiatry, LLC
BFLCNHP
Jessica Pigott
Phone: (678) 615-7032
2150 Peachford Road Suite Q
Atlanta GA 30338
Agency Email: manager@ympsychiatry.com
Expiration Date: 2024-08-31
Sent to Facility: 2019-02-13
Sent to Provost:
Sent to Legal:
Completed: 2021-08-13
Requester Name: Lisa Williams
Document 1: Young Minds Psychiatry, LLC
Document 2:
Document 3:
Comment: Please renew; original request 9/2018. lyw
This is across from Peachford and this MD does see
patients at Peachford Hospital. Additional Office opening
June 2016: 10475 Medlock Bridge
Road, #410, Johns Creek, GA. LYW
6/14/19 Clinic not taking students at this time. LYW will
re-submit contract request at a later date.
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Northwest Behavioral Medicine
BFLCNHP
Lisa Banov
Phone: (770) 422-2009
108 Margaret Ave NE
Marietta GA 30060
Agency Email: Lisa@nbmedicine.com
Expiration Date: 2022-02-28
Sent to Facility: 2022-02-02
Sent to Provost: 2019-02-26
Sent to Legal:
Completed: 2019-03-01
Requester Name: Lisa Williams
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: 2/19 - Please renew.
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Cordero Associates
Department of Occupational Therapy
Miliagros Cordero
Phone: 770 393 9901
2320 Perimeter Park
Chamblee Ga 30341
Agency Email: mili@ittsforchildren.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-11
Requester Name: Karen McWaters
Document 1: Final Expires June 2023 ...93630pdf
Document 2:
Document 3:
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Carroll County Primary Health Care Clinic
School of Nursing
Cheryl Toney
Phone: 770-836-0103
4248 Mt. Zion Road
Mount Zion GA 30150
Agency Email: cvwtoney@gmail.com
Expiration Date: 2018-10-31
Sent to Facility: 2015-11-10
Sent to Provost: 2015-12-07
Sent to Legal:
Completed: 2015-12-10
Requester Name: Sheryl Newberry
Document 1:
Document 2:
Document 3:
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Northside Pediatrics
BFLCNHP
Vicki Tittle
Phone: 404-256-2688 x140
250 Parkbrooke Suite 200
Woodstock GA 30189
Agency Email: vt@nspeds.org
Expiration Date: 2022-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-10-07
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Northside Pediatrics Orig 2016
Document 2: Exp Aug2022 doc03471720191023101652
Document 3:
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Childrens Special Services LLC
Department of Occupational Therapy
Susan Orloff
Phone: 770 394-9791
7501 Auden Trail
Atlanta Georgia 30350
Agency Email: sorloffotr@aol.com
Expiration Date: 2019-02-28
Sent to Facility: 2022-09-19
Sent to Provost: 2016-02-24
Sent to Legal:
Completed: 2016-03-08
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Caritas Medical Center
School of Nursing
Leo Ovadje
Phone:
105 North Park Trail Suite 300
Stockbridge GA 30281
Agency Email: lopovadje@hotmail.com
Expiration Date: 2019-02-28
Sent to Facility: 2016-02-26
Sent to Provost: 2016-03-11
Sent to Legal:
Completed: 2016-05-09
Requester Name: Lisa Cranwell-Bruce
Document 1:
Document 2:
Document 3:
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We Play Atlanta
Department of Occupational Therapy
Florie Glusman
Phone: 404 636 5272
1816 Briarwood Industrial Ct NE suite a
Brookhaven Georgia 30329
Agency Email: florie@weplayatlanta.com
Expiration Date: 2023-01-31
Sent to Facility: 2023-07-06
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2020-02-11
Requester Name: Karen McWaters
Document 1: exp jan 2023 ...213164935pdf
Document 2:
Document 3:
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Southern Fried Nutrition Services, LLC
Department of Nutrition
Sherry Collins
Phone: 404-702-4580
490 Woodvalley Drive
Marietta Georgia 30064
Agency Email: dietitiansherry@gmail.com
Expiration Date: 2019-11-30
Sent to Facility: 2016-11-09
Sent to Provost: 2016-12-22
Sent to Legal:
Completed: 2017-01-06
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non-clinical agreement.
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Adventist Health System/Sunbelt, Inc. b/d/a Florida Hospital
Department of Nutrition and Respiratory Therapy
Debbie Skunkard
Phone: 407-200-2896
900 Winderly Place Suite 1500
Maitland FL 32751
Agency Email: debra.skunkard@flhosp.org
Expiration Date: 2018-01-31
Sent to Facility: 2015-06-19
Sent to Provost: 2015-12-10
Sent to Legal:
Completed: 2015-12-22
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Mount Vernon Medical Center
School of Nursing
Nancy Fowler
Phone: 404-303-9945
755 Mount Vernon Highway Suite 430
Sandy Springs GA 30328
Agency Email: none@gmail.com
Expiration Date: 2020-07-31
Sent to Facility: 07/19/2017
Sent to Provost: 2017-07-26
Sent to Legal:
Completed: 2017-07-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please fax contract. LYW
MOU Faxed- 7/19/17
Sent to legal 7-26
MOU COMPLETED
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Randstad US
Department of Nutrition
Leigh Dobbs
Phone: 770-303-6735
3625 Cumberland Boulevard, 600
Atlanta Georgia 30339
Agency Email: leigh.dobbs@randstadusa.com
Expiration Date: 2018-11-30
Sent to Facility: 2018-09-06
Sent to Provost: 2018-09-12
Sent to Legal:
Completed: 2018-09-17
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Non Clinical Agreement.
9/6/18 MOU emailed
9/12/18 to Legal
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Northside Medical Specialist, LLC
School of Nursing
Shayla Roberts
Phone: 770-704-9499
145 Riverstone Terrace Suite 100
Canton GA 30114
Agency Email: northside145@hotmail.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: 2/11 - please renew. LYW
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Southeastern Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Lisa Hesser
Phone: 770-400-6690
600 Celebrate Life Parkway
Newnan GA 30265
Agency Email: lisa.hesser@ctca-hope.com
Expiration Date: 2020-01-22
Sent to Facility:
Sent to Provost: 2018-12-12
Sent to Legal:
Completed: 2019-01-22
Requester Name: Jessica Todd
Document 1: Final Auto Renews
Document 2:
Document 3:
Comment: 12/12/18 Sent facilitys documents to legal for review.
1/10/19 Sent back to facility with Lombard changes
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A Step Ahead Physical Therapy
Department of Physical Therapy
Kimberly Richards
Phone: 770-998-6636
930 Woodstock Road
Roswell GA 30075
Agency Email: kim@asaphysicaltherapy.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-02-28
Sent to Provost: 2019-04-09
Sent to Legal:
Completed: 2021-11-15
Requester Name: Carla Huggins
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Signature Healthcare of Buckhead dba LP Atlanta, LLC
Department of Physical Therapy
Melody Shannon
Phone: 404-351-6041
54 Peachtree Park Drive NE
Atlanta GA 30309
Agency Email: therapy.buckhead@signaturehealthcarellc.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2: view
Document 3:
Comment: Site terminated contract on 9-30-22 see attached letter.
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Signature Healthcare of Marietta dba LP Marietta, LLC
Department of Physical Therapy
Gregory Skaggs
Phone: 770-422-2451
811 Kennesaw Avenue
Marietta GA 30060
Agency Email: therapy.marietta@signaturehealthcarellc.com
Expiration Date: auto renews
Sent to Facility:
Sent to Provost: 2019-07-10
Sent to Legal: 2019-06-20
Completed: 2019-11-07
Requester Name: Carla Huggins
Document 1: Auto Renews
Document 2:
Document 3:
Comment: Auto renews annually
Separate contracts required for Signature HC Buckhead and
Signature HC Marietta
6/6/19 inquired on whom to send amendment to add Nursing
program
6/10/19 Facility is sending amendment to add nursing -
updated contact info.
6/20/19 Sent amendment to legal for review. Send back
signed agreement to contracts@signaturehealthcarellc.com
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Primary Health Clinic, Clayton Station
School of Nursing
Tara Henry
Phone: 678-466-5590
5809 Northlake Drive Bldg 1000
Morrow GA 30260-0285
Agency Email: patrickwashington@clayton.edu
Expiration Date: 2018-11-30
Sent to Facility: 2015-11-24
Sent to Provost: 2015-12-01
Sent to Legal:
Completed: 2015-12-10
Requester Name: Sheryl Newberry
Document 1: view
Document 2:
Document 3:
Comment: Paulester, This clinic is separate from the student
health
clinic that we have a contract with (Contact: Ms. Polly
Parks). I have to have a separate contract to place
students with Dr. Washington. Thanks,SN
Sent to Legal for Provost signature 12/3/15.
MOU emailed 11/24.
===
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Family Medical Center of Northeast Georgia
School of Nursing
William Ellmore
Phone: 770-822-3031
555 Old Norcross Road Suite 100
Lawrenceville GA 30046
Agency Email: wilel0308@aol.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: 2/8/2019 - Please renew
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Dublin Obstetrics & Gynecology
School of Nursing
Newton Chism, Jr.
Phone: 478-272-8580
2400 Bellevue Road # 23
Dublin GA 31201
Agency Email: Dr_chine@bellsouth.net
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: 2/8/2019 - please renew
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Rainbow Kids Pediatrics
BFLCNHP
Carol Herrmann
Phone: 404-378-1998
150 E. Ponce DeLeon Avenue Suite 235
Decatur GA 30030
Agency Email: rkpeds@gmail.com
Expiration Date: 2023-02-28
Sent to Facility: 2023-02-14
Sent to Provost: 2020-03-05
Sent to Legal:
Completed: 2020-03-16
Requester Name: Lisa Williams
Document 1: exp feb2023 ...6133608pdf
Document 2:
Document 3:
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East Metro Internal Medicine
School of Nursing
Anil Desai
Phone: 770-786-9499
3641 GA Hwy 20 South
Conyers GA 30013
Agency Email: ajd30094@yahoo.com
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-27
Sent to Provost: 2024-01-04
Sent to Legal:
Completed: 2024-01-11
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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West Atlanta Pediatrics
BFLCNHP
Wendy McCormick
Phone: 770-739-9292
915 Thornton Road
Lithia Springs GA 30122
Agency Email: wendymccormick18@gmail.com
Expiration Date: 2025-04-30
Sent to Facility: 2019-02-13
Sent to Provost: 2019-02-14
Sent to Legal:
Completed: 2022-05-03
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment:
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Faith in Serving Humanity
BFLCNHP
Sheila Rhodes
Phone: 678-635-8378
226 Alcovy Street
Monroe GA 30655
Agency Email: Scanlrhodes1952@gmail.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-02-14
Sent to Provost:
Sent to Legal:
Completed: 2022-05-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Georgia Southwestern State University-Hershel Health Center
School of Nursing
Natalie Thomas
Phone: 229-931-2235
800 GSW State University Drive 1st Floor, Rosalynn Carter HHS Bldg
Americus GA 31709
Agency Email: natalie.thomas@gsw.edu
Expiration Date: 2019-03-31
Sent to Facility: 2016-03-24
Sent to Provost: 2016-04-04
Sent to Legal:
Completed: 2016-04-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 4/30/19 marked inactive due to facility not wanting to
renew contract with us.
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Peachtree Behavioral Health
School of Nursing
Stuart Davis
Phone: 770-486-8600
16 Eastbrook Bend 202B
Peachtree City GA 30269
Agency Email: studavismd@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2018-08-01
Sent to Provost: 2018-08-20
Sent to Legal:
Completed: 2018-08-28
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: renewal sent 8/1/18
8/20/18 To legal
8/28/18 Complete, 9/4/18 emailed to all parties
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Annandale Village
School of Nursing
Julie Ferguson
Phone: 770-932-4868
3500 Annandale Lane
Suwanee Georgia 30024
Agency Email: julie.ferguson@annandale.org
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-07-20
Requester Name: Regena Spratling
Document 1: Annandale Village
Document 2:
Document 3:
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View Point Health-NP
School of Nursing-NP
Derek Singleton
Phone: 678-209-2710
175 Gwinnett Drive
Lawrenceville GA 30046
Agency Email: parul.bakshi@vphealth.org
Expiration Date: 2018-12-31
Sent to Facility: 2016-01-16
Sent to Provost: 2016-02-01
Sent to Legal:
Completed: 2016-02-18
Requester Name: Tia Townsend
Document 1:
Document 2:
Document 3:
Comment: does not wish to renew
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Atlanta Addiction Recovery Center
School of Nursing
Angela Dainas
Phone: 770-232-6104
1640 Powers Ferry Road SE Building 6, Suite 100
Marietta GA 30067
Agency Email: adainas@rivermendhealth.com
Expiration Date: 2020-08-31
Sent to Facility: 2017-08-01
Sent to Provost: 2017-08-22
Sent to Legal:
Completed: 2017-08-28
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Complete
|
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OB/GYN Specialists of North Atlanta
School of Nursing
Angie Minge
Phone: 706-235-6539
330 Turner McCall Blvd. Suite 107
Rome Georgia 30165
Agency Email: obgynspecialistsofnatl@gmail.com
Expiration Date: 2019-01-31
Sent to Facility: 2018-11-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Beverly Roseberry
Document 1:
Document 2:
Document 3:
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Therapyland
Department of Physical Therapy
Thane Brooks
Phone: 678-648-7644
6505 Shiloh Road 100
Alpharetta GA 30005
Agency Email: thane@therapyland.net
Expiration Date: 2019-01-31
Sent to Facility: 2016-01-15
Sent to Provost: 2016-01-27
Sent to Legal:
Completed: 2016-02-11
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
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Georgia Institute of Technology
School of Nursing
Rebecca Baker
Phone: 404-894-1434
Stamps Health Services
Atlanta GA 30332
Agency Email: shan.baker@gatech.edu
Expiration Date: no expiration date
Sent to Facility:
Sent to Provost: 2011-02-08
Sent to Legal:
Completed: 2011-03-01
Requester Name: Beverly Roseberry
Document 1:
Document 2:
Document 3:
Comment: No Expiration date or renewal required unless either party
requests a change in language.
1/17/19 reviewed by both parties. Ok "As is".
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Morrison Healthcare
Department of Nutrition
Alan Levine
Phone: 404-616-1772
80 Jesse Hill Jr Dr SE, Atlanta
Atlanta GA 30303
Agency Email: alanlevine@iammorrison.com
Expiration Date: 2019-01-31
Sent to Facility: 2016-01-19
Sent to Provost: 2016-01-19
Sent to Legal:
Completed: 2016-01-26
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement.
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Genesys GYN
School of Nursing
Verna Thornton
Phone: 770-486-0353
245 Greencastle Road
Tyrone GA 30290
Agency Email: genesysgyn30290@gmail.com
Expiration Date: 2019-01-31
Sent to Facility: 2018-11-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Beverly Roseberry
Document 1:
Document 2:
Document 3:
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Precious L. Braswell M.D., OB/GYN, LLC
School of Nursing
Precious Braswell
Phone: 404-344-9333
2885 Headland Drive
Atlanta GA 30344
Agency Email: pbraswell@hotmail.com
Expiration Date: 2019-01-31
Sent to Facility: 2018-11-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Beverly Roseberry
Document 1:
Document 2:
Document 3:
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Piedmont Internal Medicine
BFLCNHP
Mary Phillips
Phone: 404-351-7467 x4221
4890 Roswell Road Suite 100
Atlanta GA 30342
Agency Email: mary.phillips@pimapc.com
Expiration Date: 2025-08-31
Sent to Facility: 2019-07-09
Sent to Provost: 2019-07-15
Sent to Legal:
Completed: 2022-09-12
Requester Name: Lisa Williams
Document 1: Final Expires august 2022
Document 2:
Document 3:
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Columbus Orthopaedic Clinic and Outpatient Center
Department of Physical Therapy
Chasady Oswalt
Phone: 662-370-1804
670 Leigh Drive
Columbus MS 39705
Agency Email: coswalt@columbusortho.com
Expiration Date: 2023-01-31
Sent to Facility: 2023-03-24
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2020-02-11
Requester Name: Carla Huggins
Document 1: exp jan 2023 ...213165015pdf
Document 2:
Document 3:
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Georgia Hand, Shoulder & Elbow
Department of Occupational Therapy
Hannah Beaman
Phone: 404-355-0069
2061 Peachtree Road, NE Suite 450
Atlanta Georgia 30309
Agency Email: hbeaman@gahand.org
Expiration Date: 2026-01-31
Sent to Facility: 2020-02-11
Sent to Provost: 2020-02-11
Sent to Legal:
Completed: 2022-09-23
Requester Name: Jennifer Nelson
Document 1: exp jan 2020 ...Ga HandShoulderElbow
Document 2:
Document 3:
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Grady Memorial Hospital Corporation d/b/a/Grady Health System-OT,PT,ST
Department of Physical Therapy
Sika Ametu
Phone: 404 668-2377
80 Jesse HIll Jr. Dr. SE
Atlanta GA 30303
Agency Email: sametu@gmh.edu
Expiration Date: 2022-09-29
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment:
|
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Peachtree Orthopedics Physical Therapy
Department of Occupational Therapy
Melissa Thurlow
Phone: 770 617-9667
5505 Peachtree Dunwoody suite 250
Atlanta GA 30342
Agency Email: mthurlow@pocatlanta.com
Expiration Date: 2022-05-31
Sent to Facility: 2019-11-22
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Piedmont; 2001 Peachtree Rd, Suite 700, Atl 30309 (MOB across
from Piedmont hospital)
West Paces; 3200 Downwood Circle, Suite 700, Atl 30327
Alpharetta; 11800 Amber Park Drive, Suite 200, Alpha 30009
(across from Avalon)
College Park; 1901 Phoenix Blvd, Suite 120, College Park 30349
Duluth; 3870 Pleasant Hill Road, Suite 1, Duluth 30096
Northside; 5505 Peachtree Dunwoody Road, Suite 590, Atl 30342
Woodstock; 105 Smokehill Lane, Suite 120, Woodstock, 30188
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Veritas Collaborative
Department of Nutrition
Hilmar Wagner
Phone: (770) 871-3754
6600 Peachtree Dunwoody Rd #150
Atlanta ga 30328
Agency Email: Hilmar.Wagner@accanto.com
Expiration Date: 2022-08-31
Sent to Facility: 2019-09-12
Sent to Provost: 2019-11-22
Sent to Legal: 2019-07-29
Completed: 2019-12-09
Requester Name: jessica Todd
Document 1: Final Expires August 2022...93706pdf
Document 2:
Document 3:
Comment: Clinical Agreement
Please send to Hilmar and Holly.
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Medical Acupuncture and Nutrition, Inc
Department of Nutrition
Yu Kang
Phone: 4042946284
3841 Holcomb Bridge Rd
Norcross GA 30092
Agency Email: yukangluhua@yahoo.com
Expiration Date: 2024-01-31
Sent to Facility: 2018-10-31
Sent to Provost: 2018-11-01
Sent to Legal:
Completed: 2020-12-23
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: clinical agreement.
May need to call. She does not respond to email well.
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Roosevelt Warm Springs Rehabilitation & Specialty Hospitals, Inc.
Akenna Ellison
Phone: 706-655-5308
P.O. Box 280
Warm Springs GA 31830
Agency Email: AKELLISON@augusta.edu
Expiration Date:
Sent to Facility:
Sent to Provost: 2018-10-19
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2: view
Document 3:
Comment: renewal initiated by facility. sent their MOU to legal for
review. MOU includes all programs.
11/2/18 Legal review complete, routing to provost
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Atlanta VA Medical Center-OT
Department of Occupational Therapy
Chequita Owen-Carter
Phone: 404-321-6111 ext 6640
Education Support Services Line (141) 1670 Clairmont Road
Decatur Ga 30033
Agency Email: chequita.owen-carter@va.gov
Expiration Date:
Sent to Facility: 2016-02-04
Sent to Provost: 2016-10-25
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: They need a seperate Contract for OT. Chequita Owen-Carter
is who the Director Of OT told me we should contact. I
know the other contracts say Wilma West. Sent to Legal
for Provost signature 10/20. Sent to Facility 10/28 for
signature.
Sent email to Ms. Owen-Carter to send MOU 5/10/16.
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Enterprise Family Health Care
School of Nursing
Dana Durden
Phone: 478-475-9880
2192 Ingleside Avenue
Macon GA 31204
Agency Email: drrantz@cox.net
Expiration Date: 2019-06-30
Sent to Facility: 2016-07-07
Sent to Provost: 2016-07-14
Sent to Legal:
Completed: 2016-07-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Per Clinical Coordinator, Lisa Williams,site is not
appropriate for student clinicals at this time.
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WST Enterprises, INC
Department of Nutrition
Wande Okunoren-Meadows
Phone: 404-361-8886
993 Forest Ave
Forrest Park GA 30297
Agency Email: littleoneslearningcenterga@gmail.com
Expiration Date: 2025-10-31
Sent to Facility: 2019-10-22
Sent to Provost: 2019-10-28
Sent to Legal:
Completed: 2023-02-02
Requester Name: Jessica Todd
Document 1: Exp Oct 2022 doc03516420191030160955
Document 2:
Document 3:
Comment: non clinical agreement
|
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|
United Way of Greater Atlanta
Department of Occupational Therapy
Jesica Parham
Phone: 404-614-1022
100 Edgewood Ave.
Atlanta GA 30303
Agency Email: jparham@unitedwayatlanta.org
Expiration Date: 2020-07-31
Sent to Facility: 2020-04-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
|
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|
Emory University Hospital Midtown - OT
Department of Occupational Therapy
Barbara Hewett
Phone: 404 712 2574
550 Peachtree St NE
Atlanta Ga 30308
Agency Email: barbara.hewett@emoryhealthcare.org
Expiration Date: 01/01/2026
Sent to Facility: 2019-04-09
Sent to Provost: 2018-12-14
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1: Amendment Agreement.pdf
Document 2: original agreement expired Dec 2019
Document 3:
Comment: Amendment extending agreement OT only to Dec 2022
5/4/2020 Sent B. Hewett email asking to add RT, PT, Speech and
other programs.
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All about Kids PEDIATRICS
Physical Therapy
Amanda Bennett
Phone: 678-646-0404
2000 Riverside Parkway Suite 207
Lawrenceville GA 30043
Agency Email: amanda.bennett@allaboutkidsgeorgia.com
Expiration Date: 2020-04-30
Sent to Facility: 2023-03-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
|
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|
Uptown Pediatrics
School of Nursing
Nikki Williams
Phone: 706-507-5437
104 14th Street
Columbus GA 31901
Agency Email: nwilliams@youruptownpeds.com
Expiration Date: 2019-03-31
Sent to Facility: 2016-03-29
Sent to Provost: 2016-04-21
Sent to Legal:
Completed: 2016-05-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/5/2019 - This practice declined to renew the MOU. LYW
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Wholesome Wave Georgia
Department of Nutrition
Sara Berney
Phone: 4049980051
2033 Hosea L Williams Dr NE
Atlanta GA 30317
Agency Email: sara@wholesomewavegeorgia.org
Expiration Date: 2020-04-30
Sent to Facility: 2017-04-27
Sent to Provost: 2017-04-27
Sent to Legal:
Completed: 2017-05-15
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Atlanta Behavioral Medicine
BFLCNHP
Mohammed Ahmad
Phone: 678-205-4322
2150 Peachford Rd Suite G
Atlanta GA 30338
Agency Email: info@abmpsych.com
Expiration Date: 2024-03-31
Sent to Facility: 2019-01-17
Sent to Provost:
Sent to Legal:
Completed: 2021-08-05
Requester Name: Lisa Williams
Document 1: Atlanta Behavioral Med Orig 2016
Document 2:
Document 3:
Comment:
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Correct Care Solutions
School of Nursing
William Kissell
Phone: 678-232-3576
1283 Murfreesboro Road Suite 500
Nashville TN 37217
Agency Email: BKissel@correctcaresolutions.com
Expiration Date: NO EXPIRATION DATE
Sent to Facility: 2016-05-12
Sent to Provost: 2016-06-28
Sent to Legal:
Completed: 2016-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covers Clayton, DeKalb,& Rockdale County jails.
NO Expiration date, Either party can terminate with 30
days
notice. 1/15/19 Correct Care merged, now WellPath. Per B.
Kissel - It is just a branding change at this time , both
contracts remain under the name of CCS. No need to
change.
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Pediatric Ear, Nose and Throat of Atlanta
BFLCNHP
Tameka Johnson
Phone: 404-255-2033
5461 Meridian Mark Road, NE Suite 130
Atlanta Georgia 30342
Agency Email: tjohnson@childrensent.com
Expiration Date: 2022-02-28
Sent to Facility: 2022-02-02
Sent to Provost: 2019-03-01
Sent to Legal:
Completed: 2019-03-29
Requester Name: Lisa Williams
Document 1: Pediatric ENT Original 2016
Document 2: Renewal Expires February 2022
Document 3:
Comment:
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Cobb County School District
Department of Nutrition
William Snead
Phone: 770-420-4983
6975 Cobb International Blvd
Kennesaw GA 30152
Agency Email: William.Snead@cobbk12.org
Expiration Date: 2022-02-28
Sent to Facility: 2022-01-18
Sent to Provost: 2019-01-17
Sent to Legal:
Completed: 2019-01-30
Requester Name: Jessica Todd
Document 1:
Document 2: Final Expires Feb 2022
Document 3:
Comment: Nonclinical
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Central Georgia Rehabilitation Hospital
Department of Occupational Therapy
Patti Smith
Phone: 478-201-6536
3351 Northside Drive
Macon GA 31210
Agency Email:
Expiration Date: 2017-05-31
Sent to Facility: 2017-02-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Renewal snail-mailed.
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Ahmed Medical Center
School of Nursing
Aly Ahmed
Phone: 678 284 1008
245 Country Club Drive 300B
Stockbridge GA 30281
Agency Email: Alyahmedmd@yahoo.com
Expiration Date: 2019-02-28
Sent to Facility: 2019-01-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 4/30/19 per Lisa Williams, site is not interested in
renewing. marked inactive
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Madison Medical Associates, PC
School of Nursing
Stephanie Bobo
Phone: 706-752-0322
1550 Eatonton Road
Madison Georgia 30650
Agency Email: stephaniemmapc@gmail.com
Expiration Date: 2019-07-31
Sent to Facility: 2016-08-02
Sent to Provost: 2016-08-02
Sent to Legal:
Completed: 2016-08-10
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Capital Regional Medical Group
School of Nursing
Brandy Cottrell
Phone: 850-878-8235
2770 Capital Medical Boulevard Suite 200
Tallahassee FL 32308
Agency Email: Brandy.Cottrell@hcahealthcare.com
Expiration Date: 2019-07-31
Sent to Facility: 2016-05-24
Sent to Provost: 2016-09-13
Sent to Legal:
Completed: 2016-09-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Institute for Behavioral Medicine
School of Nursing
Patti Prater
Phone: 770-319-8013
696 Concord Road SE
Smyrna GA 30082
Agency Email: patti@drashrafattalla.com
Expiration Date: 2020-02-29
Sent to Facility: 2017-03-09
Sent to Provost: 2017-03-21
Sent to Legal:
Completed: 2017-03-28
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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NewCare Physical Therapy
Department of Physical Therapy
Michael Wang
Phone: (678) 718-5240
4350 Peachtree Industrial Blvd. Suite 500
Norcross GA 30071
Agency Email: DrWang@newcarept.com
Expiration Date: 2026-12-31
Sent to Facility: 2023-11-09
Sent to Provost: 2024-02-01
Sent to Legal:
Completed: 2024-02-08
Requester Name: Carla Huggins
Document 1: Final Expires December 2023
Document 2:
Document 3:
Comment: cc: ptclinicaleducation@gsu.edu
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TLC Pediatrics (Teens, Little Ones & Children Pediatrics)
BFLCNHP
Tracey Childs-Blander
Phone: 404-691-4321
2600 Martin Luther King Jr. Blvd Suite 206
Atlanta Georgia 30311
Agency Email: tcblander@hcbms.com
Expiration Date: 2022-06-30
Sent to Facility: 2022-06-01
Sent to Provost: 2019-07-08
Sent to Legal:
Completed: 2019-08-09
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: please renew
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North Atlanta Womens Specialists
School of Nursing
Lori Connor
Phone: 404-256-4667
5780 Peachtree Dunwoody Road Suite 195
Atlanta GA 30342
Agency Email: lconner@awhg.org
Expiration Date: 2019-06-30
Sent to Facility: 2019-10-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 10/1/19 - please renew
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Children and Family Programs at Christian City
Department of Occupational Therapy
Michaela Guthrie
Phone: 7709643390
7501 Red Oak Rd
Union City Ga 30291
Agency Email: mguthrie@christiancity.org
Expiration Date: 2024-04-30
Sent to Facility: 2016-06-09
Sent to Provost:
Sent to Legal:
Completed: 2021-06-08
Requester Name: Carolyn Podolski
Document 1: Childrens and Family Programs at Christian City
Document 2:
Document 3:
Comment: MOU emailed
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Christian City Senior Services
Department of Occupational Therapy
Steve Sheets
Phone: 678-466-1091
7300 Lester Rd
Union City Ga 30291
Agency Email: ssheets@christian-city.org
Expiration Date:
Sent to Facility: 2022-07-14
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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FOCUS
Department of Occupational Therapy
Lucy Cusick
Phone: 770 234-9111
3825 Presidential Parkway 103
Atlanta GA 30340
Agency Email: lucy@focus-ga.org
Expiration Date: 12/31/2025
Sent to Facility: 2016-06-09
Sent to Provost: 2016-08-16
Sent to Legal:
Completed: 2016-08-24
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Brooks Rehabilitation
Department of Physical Therapy
Shelby English
Phone: (904) 345-7361
3599 University Blvd S
Jacksonville Florida 32216
Agency Email: Brooks IHLStudent
Expiration Date: 2022-01-03
Sent to Facility: 2022-02-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: ExpJan2022 BrooksRehab forProvost - signed
Document 2:
Document 3:
Comment: Sent edits to Brooks 2/12/24
sent template to legal for review
Facility us/es their own template
Please copy ptclinicaleducation@gsu.edu
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Medlock Pediatrics
BFLCNHP
Marie Batlle
Phone: 770-813-9775
3497 Duluth Park Lane
Duluth GA 30096
Agency Email: abatlle@bellsouth.net
Expiration Date: 2024-06-30
Sent to Facility: 2016-06-10
Sent to Provost: 2016-06-24
Sent to Legal:
Completed: 2016-06-29
Requester Name: Lisa Williams
Document 1: Medlock Pediatrics
Document 2:
Document 3:
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Bio-Medical Applications of Georgia
Department of Nutrition
Bisma Habib
Phone: 000-000-0000
5825 Glenridge Drive NE
Atlanta Ga 30328
Agency Email: bisma.habib@fmc-na.com
Expiration Date: 201
Sent to Facility: 2018-01-12
Sent to Provost: 2018-01-12
Sent to Legal:
Completed:
Requester Name: jessica Todd
Document 1:
Document 2:
Document 3:
Comment: emailed and signed by provost. emailed to facility for
signature
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Cherokee Internal Medicine
School of Nursing
Linda Prins
Phone: 678-238-0301
1192 Buckhead Crossing Suite C
Woodstock Georgia 30189
Agency Email: linda.prins@cherokeeim.com
Expiration Date: 2019-06-30
Sent to Facility: 2016-06-20
Sent to Provost: 2016-07-01
Sent to Legal:
Completed: 2016-08-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Get Well Urgent Care
School of Nursing
Jasmine McDaniel
Phone: 404-937-3508
6842 Douglas Boulevard Suite K
Douglasville Georgia 30135
Agency Email: jmcdaniel@getwellga.org
Expiration Date: 2019-06-30
Sent to Facility: 2016-06-22
Sent to Provost: 2016-07-21
Sent to Legal:
Completed: 2016-08-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta International PT, Inc.
Department of Physical Therapy
Sergio Hernandez
Phone: 770-622-2532
3965 Steve Reynolds Blvd Suite G
Norcross GA 30093
Agency Email: sergio.hernandez@atlantainternationalpt.com
Expiration Date: 2022-02-28
Sent to Facility: 2024-01-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires Feb 2022 ...93457pdf
Document 2:
Document 3:
Comment: sent request on 3/24/2023 and 7/30/2023
Please copy ptclinicaleducation@gsu.edu
Sent emails in March and July-7/10/23
sent previous contract 2/01/2022 no response
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Department of Veterans Affairs - Veteran Integrated Service Network 7
School of Nursing
Laura Vertin
Phone: 478-272-1210 x2435
1826 Veterans Boulevard
Dublin GA 31021
Agency Email: Laura.Vertin@va.gov
Expiration Date: 2026-05-01
Sent to Facility: 2016-06-29
Sent to Provost: 2016-08-10
Sent to Legal:
Completed: 2016-08-22
Requester Name: Lisa Williams
Document 1: 2021 Affiliation Agreement
Document 2:
Document 3:
Comment: Sent to Legal for review 6/29/16. Sent to Legal for Provost
signature 8/2/16. Sent to Facility for signature 8/12.
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Norcross Cooperative Ministry
School of Nursing
Shirley Cabe
Phone: 770-263-0013
2275 Mitchell Road
Norcross GA 30071
Agency Email: shirley@norcrossco-op.org
Expiration Date: 2020-02-29
Sent to Facility: 2017-03-09
Sent to Provost: 2017-03-20
Sent to Legal:
Completed: 2017-04-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Apple Care Immediate Care
School of Nursing
Questa Tingler
Phone: 912-264-9111
401 Mall Avenue Suite 202E
Savannah GA 31406
Agency Email: QTingler@applecaredoctors.com
Expiration Date: 2019-07-31
Sent to Facility: 2016-07-15
Sent to Provost: 2016-07-25
Sent to Legal:
Completed: 2016-08-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Macon Office/4795 Riverside Drive, Macon, GA 31210
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Duke University Affiliated Physicians, Inc.
School of Nursing
Ellen Hegarty
Phone: 919-283-4925
Duke University Health System, Inc.
Durham NC 27710
Agency Email: donna.mosley@duke.edu
Expiration Date: 2018-04-09
Sent to Facility: 2016-07-20
Sent to Provost: 2017-02-17
Sent to Legal:
Completed: 2017-04-10
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Automatic i year renewals unless either party terminates in
writing.
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Center for Disease Control: Worklife Wellness Office
Department of Nutrition
Beverly King
Phone: 404-639-0287
1600 Clifton Road, NE Mailstop D57
Atlanta GA 30329
Agency Email: bxe1@cdc.gov
Expiration Date: 2025-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-06-03
Sent to Legal:
Completed: 2022-04-26
Requester Name: Jessica Todd
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Non clinical agreement renewal JT requested 3/28
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Crisp Regional Convenient Care
School of Nursing
Geraldine Anderson
Phone: 229-276-2000
216 Hospital Drive
Cordele GA 31015
Agency Email: ganderson@crispregional.org
Expiration Date: 2019-07-31
Sent to Facility: 2016-08-02
Sent to Provost: 2016-08-08
Sent to Legal:
Completed: 2016-08-10
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Providence Womens Healthcare
School of Nursing
Amanda Zimmerman
Phone: 770-670-6170
4035 Johns Creek Parkway
Suwanee GA 30024
Agency Email: zimmerman.cnm@gmail.com
Expiration Date: 2021-04-30
Sent to Facility: 2021-03-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Other Locations Dunwoody and Roswell
completed
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First Foundation Medical Clinic
School of Nursing
Seyi Ajayi
Phone: 678-546-2840
2930 Horizon Park Drive Suite C
Suwanee Georgia 30024
Agency Email: Clinicf@bellsouth.net
Expiration Date: 2022-07-31
Sent to Facility: 2022-06-15
Sent to Provost: 2019-08-30
Sent to Legal:
Completed: 2019-09-16
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
Comment: 6/19 renewal initiated
firstfoundationmed@gmail.com
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R Patel Family Medicine
BFLCNHP
Rajendra Patel
Phone: 770-998-5000
2965 Johnson Ferry Road #D
Marietta Georgia 30062
Agency Email: familypractice30@hotmailcom
Expiration Date: 2025-07-31
Sent to Facility: 2019-08-07
Sent to Provost: 2019-09-04
Sent to Legal:
Completed: 2022-08-08
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
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North Chattahoochee Family Physicians
School of Nursing
H. Lonnie Gardiner III
Phone: 770-497-1555
11459 Johns Creek Parkway Suite 250
Johns Creek GA 30097
Agency Email: lonnie.gardiner@gmail.com
Expiration Date: 2019-07-31
Sent to Facility: 2016-08-04
Sent to Provost: 2016-08-08
Sent to Legal:
Completed: 2016-08-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Aesthetic Specialty Centre
School of Nursing
Kristin Sparks
Phone: 770-393-9000
1825 Old Alabama Road
Roswell GA 30076
Agency Email: kristin@asc-psd.com
Expiration Date: 2019-07-31
Sent to Facility: 2016-08-04
Sent to Provost: 2016-08-11
Sent to Legal:
Completed: 2016-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta GYN Center
BFLCNHP
Rita Sharma
Phone: 770-723-1545
1922 Northlake Parkway
Tucker Georgia 30084
Agency Email: info@atlantagyncenter.net
Expiration Date: 2019-08-31
Sent to Facility: 2016-08-26
Sent to Provost: 2016-09-13
Sent to Legal:
Completed: 2016-09-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Emory Decatur Hospital
Julie Miller
Phone:
2701 N. Decatur Road
Decatur GA 30033
Agency Email:
Expiration Date: 2024-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-11-22
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
Comment: Please check, may be covered under Emory Healthcare contract.
I will email copies of contracts to Wanda Little that Julie
wants reviewed and completed to renew the contract.
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Optimal Health Care
BFLCNHP
Paul Chastang
Phone: 770-485-3837
1121 Johnson Ferry Road Suite 205
Marietta GA 30068
Agency Email: Info@1OptimalHealth.com
Expiration Date: 2025-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-11-07
Sent to Legal:
Completed: 2022-09-12
Requester Name: Lisa Williams
Document 1: Exp Aug 2022 doc...140249
Document 2:
Document 3:
Comment: 8/26 - please renew. Send to both e-mail addresses. LYW
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Innovative Therapy Concepts aka Crisp Regional Health Services
Department of Physical Therapy
Dane Newby
Phone: 478-783-4460
2 Mashburn Street
Hawkinsville GA 31036
Agency Email: d.newby@itcmgt.net
Expiration Date: 2026-11-30
Sent to Facility: 2022-03-02
Sent to Provost: 2019-08-23
Sent to Legal:
Completed: 2023-12-14
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
Sent COI requestNo response sent another email 6/08/23
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McIntosh Clinic, PC
School of Nursing
Mike Gebel
Phone: 229-225-1900
119 West Hill Street
Thomasville GA 31792
Agency Email: mgebel@mcintoshclinic.com
Expiration Date: 2020-01-31
Sent to Facility: 2017-02-14
Sent to Provost: 2017-02-15
Sent to Legal:
Completed: 2017-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Summit Ridge Hospital
School of Nursing
Angela L. Wright
Phone: 678-442-5900
250 Scenic Highway
Lawrenceville GA 30046
Agency Email: Angela.Wright@uhsinc.com
Expiration Date: 2023-04-30
Sent to Facility:
Sent to Provost: 2020-05-11
Sent to Legal: 2020-02-07
Completed: 2020-05-26
Requester Name: Lisa Williams
Document 1: ExpApr2023 databaseSummitRidgeHosp
Document 2:
Document 3:
Comment: 5/16/2023 - the site declines to renew contract.
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Buford Medical Clinic
School of Nursing
Mirela Tudorescu
Phone: 770-945-7676
4745 Nelson Brogdon Boulevard Suite 200
Buford Georgia 30518
Agency Email: mirela.bmc@gmail.com
Expiration Date: 2026-12-31
Sent to Facility: 2016-08-12
Sent to Provost: 2016-08-22
Sent to Legal:
Completed: 2024-01-11
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Premier Internal Medicine
School of Nursing
Cheryl Raper
Phone: 770-918-3991
5294 Adams Street
Covington GA 30014
Agency Email: cheryl.raper@lpnt.net
Expiration Date: 2020-08-31
Sent to Facility: 2017-08-09
Sent to Provost: 2017-08-21
Sent to Legal:
Completed: 2017-09-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Lanier Medcare P.C.
School of Nursing
Wendy Bozworth
Phone: 678-546-5059
4995 Lanier Islands Parkway Suite A
Buford Georgia 30519
Agency Email: bozworth8866@yahoo.com
Expiration Date: 2019-08-31
Sent to Facility: 2016-08-18
Sent to Provost: 2016-09-15
Sent to Legal:
Completed: 2016-09-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta Mission
School of Nursing
Zakiya Mims
Phone: 404-588-4000
P.O. Box 1807
Atlanta GA 30301
Agency Email: zakiya.mims@atlantamission.org
Expiration Date: 2019-08-31
Sent to Facility: 2016-08-22
Sent to Provost: 2017-07-05
Sent to Legal:
Completed: 2017-07-17
Requester Name: Kenya Kirkendoll
Document 1:
Document 2:
Document 3:
Comment: completed 7/7/17
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The Elaine Clark Child Development Center
Department of Occupational Therapy
Beth Schmehling
Phone: 770-458-3251
5130 Peachtree Industrial Blvd
Chamblee GA 30341
Agency Email: bschmehling@ecvc.org
Expiration Date: 2019-08-31
Sent to Facility: 2022-09-16
Sent to Provost: 2016-09-19
Sent to Legal:
Completed: 2016-10-04
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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Rehab Without Walls
Department of Occupational Therapy
Kim Pollard
Phone: 706-948-2773
1860 Atkinson Road Suite 101
Georgia Lawrenceville 30043
Agency Email: Kimnesha.polard@rehabwithoutwalls.com
Expiration Date: 2026-08-31
Sent to Facility: 2023-09-16
Sent to Provost: 2023-12-12
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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WakeMed Health & Hospitals
School of Nursing
Lara Radford
Phone: 919-350-5261
3024 New Bern Avenue
Raleigh NC 27610
Agency Email: LRadford@wakemed.org
Expiration Date: 2019-10-16
Sent to Facility: 2016-08-22
Sent to Provost: 2016-10-25
Sent to Legal:
Completed: 2016-11-09
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Courtney Sinclair, MD
School of Nursing
Jill Kasonovitch
Phone: 770-720-4100
310 Paper Trail Way #109
Canton GA 30115
Agency Email: jkasonovitch@hotmail.com
Expiration Date: 2019-08-29
Sent to Facility: 2016-08-24
Sent to Provost: 2016-08-30
Sent to Legal:
Completed: 2016-09-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Patches Nursing Center PPEC
Department of Occupational Therapy
Ashlee Casarino
Phone: 305-242-8122
335 South Krome Ave. Suite 104
Florida City Florida 33034
Agency Email: asmith120@bellsouth.net
Expiration Date:
Sent to Facility: 2022-07-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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GYN Fertility Specialists
BFLSNHP
Magdi Hanafi
Phone: 404-851-9300
5673 Peachtree Dunwoody Road 750
Atlanta GA 30342
Agency Email: mhanafi@aol.com
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-13
Sent to Provost:
Sent to Legal:
Completed: 2021-03-29
Requester Name: Lisa Williams
Document 1: GYN Fertility Specialists
Document 2: GYN Fertility Specialists
Document 3:
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Adventist Health System Georgia, Inc.
Occupational Therapy
Joan Smith
Phone: 706-602-7800 Ext. 2308
Gordon Hospital
Calhoun GA 30701
Agency Email: Joan.Smith@ahss.org
Expiration Date: 2025-07-31
Sent to Facility: 2019-04-30
Sent to Provost: 2019-04-09
Sent to Legal: 2019-04-11
Completed: 2022-07-13
Requester Name: Karen McWaters
Document 1: Final Expires July 2022
Document 2:
Document 3:
Comment: 4/11/19 Facility has their own agreement they want to use.
11.23.2021 - students and faculty must have COVID vaccination.
See attached letter.
9/5/23 - submitted contract for renewal
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Womens Healthcare Center of Georgia
School of Nursing
Brieanna Romero
Phone: 770-739-1200
4039 Atlanta Street
Powder Springs GA 30127
Agency Email: brieannaromero@icloud.com
Expiration Date: 2019-08-31
Sent to Facility: 2016-08-31
Sent to Provost: 2016-09-19
Sent to Legal:
Completed: 2016-09-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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NGHS Laurelwood NGPG Group
School of Nursing
Stephen Sorrells
Phone: 770-219-5407
200 Wisteria Drive
Gainsville GA 30501
Agency Email: Stephen.Sorrells@nghs.com
Expiration Date: 2019-08-31
Sent to Facility: 2016-09-01
Sent to Provost: 2016-10-24
Sent to Legal:
Completed: 2016-10-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta Gwinnett Womens Specialist
School of Nursing
Pricilla Davis
Phone: 770-963-2485
766 Walther Boulevard 100
Lawrenceville, GA 30046
Agency Email: none@gmail.com
Expiration Date: 2020-06-30
Sent to Facility: 2017-07-13
Sent to Provost: 2017-07-26
Sent to Legal:
Completed: 2017-07-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please fax agreement.
MOU Faxed 7-13-17
sent to legal 7/26
MOU COMPLETED
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North Roswell Internal Medicine
School of Nursing
Goga Vukotic
Phone: 770-645-0017
11050 Crabapple Road Building A Suite 104-B
Roswell GA 30075
Agency Email: theresa@northroswellinternalmedicine.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-09-13
Sent to Provost: 2016-09-15
Sent to Legal:
Completed: 2016-09-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Southern Crescent Womens Healthcare
School of Nursing
Kristie Dyson
Phone: 770-991-2200
775 Poplar Road Suite 210
Newnan GA 30265
Agency Email: kydyson@gmail.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-09-13
Sent to Provost: 2016-10-05
Sent to Legal:
Completed: 2016-10-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Blossom Therapeutics LLC
Department of Occupational Therapy
Jennifer Johnson
Phone: 541-604-0548
211 NE Revere Ave #7
Bend OR 97701
Agency Email: jenny@blossomtherapeutics.com
Expiration Date: 2022-05-31
Sent to Facility: 2024-02-07
Sent to Provost: 2019-06-14
Sent to Legal:
Completed: 2019-06-14
Requester Name: Karen McWaters
Document 1: View
Document 2:
Document 3:
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Premier Medical Clinic
School of Nursing
Victoria Marbas
Phone: 850-584--3278
315 E. Ash Street
Perry FL 32347
Agency Email: none@none.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-09-13
Sent to Provost: 2016-09-14
Sent to Legal:
Completed: 2016-09-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Pediatric & Adult Medicine, Inc.
BFLCNHP
Michelle Sewell
Phone: 404-386-6510
4153 Flat Shoals Parkway Suite 300B
Decatur GA 30034
Agency Email: pedsandadultmed@gmail.com
Expiration Date: 2022-08-31
Sent to Facility: 2024-02-14
Sent to Provost: 2019-10-31
Sent to Legal:
Completed: 2019-10-31
Requester Name: Lisa Williams
Document 1: Final Expires August 2022 doc03522220191101130933
Document 2:
Document 3:
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Milton Medical Group
School of Nursing
Savitha Shama
Phone: 678-827-9157
735 North Main Street Suite 1100
Alpharetta GA 30009
Agency Email: info@miltonmedicalgroup.com
Expiration Date: 2025-09-30
Sent to Facility: 2016-09-19
Sent to Provost: 2016-09-19
Sent to Legal:
Completed: 2016-09-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Gwinnett Clinic
BFLCNHP
Daniela Tanase
Phone: 770-266-6191
1390 W. Spring Street
Monroe GA 30655
Agency Email: help@gwinnettclinic.com
Expiration Date: 2020-09-30
Sent to Facility: 2020-09-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Lawrenceville and Monroe offices
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Optima Therapy Services
Department of Occupational Therapy
Bethany Bearden
Phone: 678-936-8695
955 Interstate Ridge Rd. Suite E
Gainesville Ga 30501
Agency Email: bethanybearden@gmail.com
Expiration Date: 2021-08-31
Sent to Facility: 2022-07-19
Sent to Provost: 2018-09-25
Sent to Legal:
Completed: 2018-10-26
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
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Primecare Pediatrics
School of Nursing
Fred Tega
Phone: 770-251-5253
15A Baynard Park
Newnan GA 30265
Agency Email: admin@Primecarepeds.com
Expiration Date: 2019-09-30
Sent to Facility: 2016-10-13
Sent to Provost: 2016-10-14
Sent to Legal:
Completed: 2016-10-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Ramon Ramos MD PC
School of Nursing
Linda Jones
Phone: 912-354-3400
460 Mall Boulevard
Savannah GA 31406
Agency Email: lj4rrmd@bellsouth.net
Expiration Date: 2019-10-31
Sent to Facility: 2016-10-13
Sent to Provost: 2017-01-10
Sent to Legal:
Completed: 2017-01-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Georgia Medical Associates, PC
School of Nursing
Aaronetta Harris
Phone: 404-299-8444
2121 Fountain Drive Suite A
Snellville GA 30078
Agency Email: a.harris@georgiamedicalassociates.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-10-19
Sent to Provost: 2016-1027
Sent to Legal:
Completed: 2016-11-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please fax contract.
other location is in Stone Mountain, GA
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Sports Rehabilitation Center
Department of Physical Therapy
Christine Olson
Phone: 404-477-8888
555 10th Street, NW
Atlanta GA 30318
Agency Email: colson@sportsrehabcenter.com
Expiration Date: 2022-10-31
Sent to Facility: 2019-06-06
Sent to Provost: 2019-08-22
Sent to Legal:
Completed: 2019-08-29
Requester Name: Carla Huggins
Document 1: Final Expires October 2022
Document 2:
Document 3:
Comment: Sports Rehabilitation Center (GA Tech, Midtown)
Sports Rehabilitation Center- Dunwoody
Sports Rehabilitation Center- Sandy Springs
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The Childrens Hospital Of Alabama
Department of Physical Therapy
Corinne Chapman
Phone: 205-638-7514
1600 7th Avenue South
Birmingham AL 35233
Agency Email: corinne.chapman@childrensal.org
Expiration Date: 2026-012-07
Sent to Facility: 2020-05-13
Sent to Provost: 2023-12-08
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please email ptclinicaleducation@gsu.edu
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The Potters Clinic
School of Nursing
Mobolaji Oyebanjo
Phone: 770-459-899
307 Old Stone Road
Villa Rica GA 30180
Agency Email: dro@thepottersclinic.org
Expiration Date: 2019-10-31
Sent to Facility: 2016-10-21
Sent to Provost: 2016-10-21
Sent to Legal:
Completed: 2016-11-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Locations:Villa Rica and Hiram.
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Carrollton Obstetrics & Gynecology, LLC
School of Nursing
Velvie Burson
Phone: 770-214-2229
156 Clinic Avenue
Carrollton GA 30117
Agency Email: velvieburson@gmail.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-08
Sent to Provost: 2016-11-08
Sent to Legal:
Completed: 2016-11-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kiddos Clubhouse
Department of Physical Therapy
Lindsey Krempa
Phone: 770-415-9165
5871 Glenridge Dr 100
Atlanta GA 30328
Agency Email: perimeter@kiddosclubhouse.com
Expiration Date:
Sent to Facility: 2022-09-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Resent updated contract request 7/10/2023
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Dr Dominic Nkwocha, MD
School of Nursing
Dominic Nkwocha
Phone: 678-324-8406
3822 Highlands Parkway
Smyrna GA 30082
Agency Email: Denkinc@yahoo.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-01
Sent to Provost: 2017-01-09
Sent to Legal:
Completed: 2017-01-18
Requester Name: Dominic Nkwocha
Document 1:
Document 2:
Document 3:
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Dekalb County School District
Department of Nutrition
Janet Stone
Phone: 6786760157
1780 Montreal Road
Tucker GA 30084
Agency Email: joyce_r_wimberly@dekalbschoolsga.org
Expiration Date: 2021-12-31
Sent to Facility: 2023-10-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical covers all schools in Dekalb Co.
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USDA Food and Nutrition Service
Department of Nutrition
Sharlyn Peter
Phone: 404-562-7078
61 Forsyth Street SW 8T36
Atlanta GA 30303
Agency Email: joi.hatch-parks@fns.usda.gov
Expiration Date: 2017-01-27
Sent to Facility: 2016-11-08
Sent to Provost: 2016-12-19
Sent to Legal:
Completed: 2017-01-13
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical agreement
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Peachtree Immediate Care
BFLCNHP
James Yost
Phone: 770-765-0490
2675 Paces Ferry Road Suite 200
Atlanta GA 30339
Agency Email: jyostmd@crhhealthcare.com
Expiration Date: Auto Renews
Sent to Facility: 2024-02-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Peachtree Immediate Care
Document 2: Peachtree Immediate Care
Document 3:
Comment: Contracts Auto Renews
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Great Expectations Unlimited
Byrdine F Lewis School of Nursing and Health Professions
Salena Barnes
Phone: 478.254.6091
640 Plum Street Units 202 and 203
Macon GA 31201
Agency Email: sbarnes@greatexpectationsga.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-16
Sent to Provost:
Sent to Legal:
Completed: 2021-03-29
Requester Name: Lisa Williams
Document 1: Greate Expectations Unlimited_exp_02-29-2024
Document 2:
Document 3:
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City Schools of Decatur
Byrdine F Lewis School of Nursing and Health Professions
Bruce Roaden
Phone: 404-371-3601
125 Electric Avenue
Decatur GA 30030
Agency Email: broaden@csdecatur.net
Expiration Date: 2026-08-31
Sent to Facility: 2018-06-21
Sent to Provost: 2024-01-16
Sent to Legal:
Completed: 2024-01-19
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Delivered to B.Roaden on 6/21. lyw
7/30/18 to legal - 9/12/18 Asked Kisha again re: MOU
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Select Rehabilitation, LLC
Department of Occupational Therapy
Meghan Rose
Phone: 877-787-3430
2600 Compass Road
Glenview IL 60026
Agency Email: hr@selectrehab.com
Expiration Date: Auto Renews
Sent to Facility: 2020-01-21
Sent to Provost:
Sent to Legal: 2019-12-16
Completed: 2020-01-23
Requester Name: Shana Finks
Document 1: Georgia State University Fully Executed OT Disc.
Document 2:
Document 3:
Comment: 12/16 back to legal with changes from facility
1/21/20 to facility for final signatures
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Duluth Family Practice, LLC
School of Nursing
Uyen Ngo
Phone: 770-858-5983
4470 Satellite Boulevard Suite 204
Duluth GA 30096
Agency Email: duluthfp@yahoo.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-09
Sent to Provost: 2016-12-09
Sent to Legal:
Completed: 2016-12-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Life Cycle OBGYN, LLC.
School of Nursing
Anne Sigouin
Phone: 404-766-8371
2739 Felton Drive
East Point Georgia 30344
Agency Email: lifecycleobgyn@gmail.com
Expiration Date: 2019-10-31
Sent to Facility: 2016-11-18
Sent to Provost: 2016-11-22
Sent to Legal:
Completed: 2016-12-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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McIntosh Trail Community Service Board
BFLCNHP
Karen Cheeseman
Phone: 770-358-8584
1435 North Expressway Suite 302
Griffin Georgia 30223
Agency Email: kwalker@Mctrail.org
Expiration Date: 2025-12-31
Sent to Facility: 2016-11-15
Sent to Provost: 2016-11-15
Sent to Legal:
Completed: 2022-03-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sebastian River Medical Center
School of Nursing
Janet Pellizze
Phone: 772-581-2073
13695 US Hwy 1
Sebastian FL 32958
Agency Email: Janet.Pellizze@sebastianrivermedical.com
Expiration Date: 2019-08-31
Sent to Facility: 2016-11-02
Sent to Provost: 2016-12-02
Sent to Legal:
Completed: 2016-12-19
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Site requested a new agreement for physician offices. Sent
to Legal for review 3/29/17.
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Lawnwood Regional Medical Center & Heart Institute
Department of Respiratory Therapy
Dee Sherwood
Phone: 772.468.4507
1700 S. 23rd Street
Ft. Pierce FL 34950
Agency Email: dee.sherwood@hcahealthcare.com
Expiration Date: 2019-02-28
Sent to Facility: 2016-12-05
Sent to Provost: 2017-02-20
Sent to Legal:
Completed: 2017-04-06
Requester Name: Chip Zimmerman
Document 1:
Document 2:
Document 3:
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Helping Hands Pediatric Therapy
Department of Occupational Therapy
Stefanie Willard
Phone: 678 4826100
470 S. Hill Street
Buford Ga 30518
Agency Email: swillard@helpinghandspediatrictherapy.com
Expiration Date: 2023-02-28
Sent to Facility: 2020-02-14
Sent to Provost: 2020-03-03
Sent to Legal:
Completed: 2020-03-06
Requester Name: Carolyn Podolski
Document 1: exp feb 2023 ...6132111 pdf
Document 2:
Document 3:
Comment: Please expedite this renewal request if possible. Thanks! -
Letitia Carelock
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Foundation Psychiatry, PC
School of Nursing
John Tumeh
Phone: 404-902-6184
35 Collier Road NW Suite 425
Atlanta GA 30309
Agency Email: drtumeh@foundationpsychiatry.net
Expiration Date: 2022-11-30
Sent to Facility: 2023-02-13
Sent to Provost: 2019-11-07
Sent to Legal:
Completed: 2019-11-07
Requester Name: Lisa Williams
Document 1: Exp Nov 2022 doc...140306
Document 2:
Document 3:
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Carolina Pediatric Therapy
Department of Occupational Therapy
Courtney Carriveau
Phone: 828 670 8056
9 West Summit Ave
Asheville NC 28803
Agency Email: cwebb@carolinapeds.com
Expiration Date: 2021-12-31
Sent to Facility: 2022-07-13
Sent to Provost: 2017-12-18
Sent to Legal:
Completed: 2018-01-19
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Ponce Primary Care
School of Nursing
Chad Costley
Phone: 404-537-2521
402 W Ponce de Leon Avenue
Decatur GA 30030
Agency Email: drcostley@ponceprimarycare.com.
Expiration Date: 2019-11-30
Sent to Facility: 2016-12-16
Sent to Provost: 2017-01-19
Sent to Legal:
Completed: 2017-01-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Little Muscles LLC
Department of Occupational Therapy
Holly Goldberg
Phone: 646 717-2971
445 Clifton Rd. NE
Atlanta GA 30307
Agency Email: littlemusclesatl@gmail.com
Expiration Date: 2019-11-30
Sent to Facility: 2019-07-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Collier County Public Schools Nutrition Services
Department of Nutrition
Ashley Wheeler
Phone: 1-239-377-0296
5775 Osceola Trail
Naples FL 34109
Agency Email: wheela1@collierschools.com
Expiration Date: 2019-12-31
Sent to Facility: 2017-01-04
Sent to Provost: 2017-03-23
Sent to Legal:
Completed: 2017-03-28
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Non Clinical.
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LP Atlanta, LLC dba Signature HealthCARE of Buckhead
School of Nursing
Annie Appelhof
Phone: 502-804-3727
12201 Bluegrass Parkway
Louisville KY 40299
Agency Email: Contracts@signaturehealthcarellc.com
Expiration Date: 2018-11-30
Sent to Facility: 2016-12-13
Sent to Provost: 2017-01-28
Sent to Legal:
Completed: 2017-02-17
Requester Name: Brandi Pinckney
Document 1:
Document 2:
Document 3:
Comment: Melody Shannon
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Braddy Preparatory Academy
BFLCNHP
Wanda Hawkins
Phone: 404.622.0506
542 Moreland Avenue
Atlanta GA 30316
Agency Email: wgchatmanmilner@yahoo.com
Expiration Date: 2020-09-30
Sent to Facility: 2020-07-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Welch Ob/GYN
School of Nursing
Gerald Welch III
Phone: 919-852-1949
300 Asheville Avenue Suite 305
Cary NC 27518
Agency Email: catina@welchobgyn.com
Expiration Date: 2019-12-31
Sent to Facility: 2017-01-10
Sent to Provost: 2017-01-19
Sent to Legal:
Completed: 2017-01-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kidzcare Pediatrics
School of Nursing
Nelson Morris
Phone: 910-483-7337
5617 Ramsey Street
Fayetteville NC 28311
Agency Email: nmorris@kidzcarepediatrics.com
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Care Connect Health
BFLCNHP
Bridget Mosley
Phone: 229-273-8881 x400
506 C Spaulding Road Suite B
Montezuma GA 31063
Agency Email: bmosley@ccthealth.org
Expiration Date: 2024-04-30
Sent to Facility: 2024-04-11
Sent to Provost:
Sent to Legal:
Completed: 2021-06-23
Requester Name: Lisa Williams
Document 1: Care Connect Health
Document 2:
Document 3:
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Kids That Can!
Department of Physical Therapy
Karen Nye
Phone: 678-632-6765
1130 Senoia Road Suite A1
Tyrone GA 30290
Agency Email: info@kidsthatcan.com
Expiration Date: 2026-12-31
Sent to Facility: 2019-06-06
Sent to Provost: 2019-06-18
Sent to Legal:
Completed: 2023-10-03
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
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Whole Family Medicine
School of Nursing
Marion Owen
Phone: 404-377-9010
465 Winn Way Suite 215
Decatur GA 30030
Agency Email: info@wholefamilymed.com
Expiration Date: 2019-12-31
Sent to Facility: 2017-01-10
Sent to Provost: 2017-01-23
Sent to Legal:
Completed: 2017-01-31
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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North Wake Pediatrics
School of Nursing
Kamini Patel
Phone: 919-848-2167
10010 Falls of Neuse Road Suite 100
Raleigh NC 27614
Agency Email: feverfewer@yahoo.com
Expiration Date: 2020-05-31
Sent to Facility: 2017-05-31
Sent to Provost: 2017-06-02
Sent to Legal:
Completed: 2017-06-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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University of Texas Medical Branch - Galveston
Department of Nutrition
Danielle Vice
Phone: 409-772-3466
301 University Blvd.
Galveston TX 77555-0359
Agency Email: jwray@utmb.edu
Expiration Date: 2020-01-31
Sent to Facility: 2017-01-17
Sent to Provost: 2017-01-24
Sent to Legal:
Completed: 2017-01-31
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Macon Family Health
School of Nursing
Ronna Slappy
Phone: 478-755-8400
2040 Bowman Park Suite A
Macon GA 31210
Agency Email: mfhc@maconfamilyhealth.com
Expiration Date: 2020-02-29
Sent to Facility: 2020-03-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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DeKalb Obgyn Affiliates
School of Nursing
Shirley Rigaud-Echols
Phone: 470-226-1601
2675 N. Decatur Road Suite 607
Decatur GA 30033
Agency Email: Shirley@dekalbobgynaffiliates.com
Expiration Date: 2023-01-31
Sent to Facility: 2019-12-19
Sent to Provost: 2020-02-05
Sent to Legal:
Completed: 2020-02-19
Requester Name: Lisa Williams
Document 1: exp jan 2023 ...3165253.pdf
Document 2:
Document 3:
Comment: per email 3/13/13 from Shirley Rigaud-Echols, Facility is
no longer offering Preceptorships. Marking inactive.
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Kids Play Therapy Center
Department of Occupational Therapy
Gretchen Clark
Phone: 678-205-5437
311 Cooper Rd.,
Loganville GA 30052
Agency Email: gretchen@kidsplaytherapy.com
Expiration Date: 2025-8-31
Sent to Facility: 2017-01-19
Sent to Provost:
Sent to Legal:
Completed: 2022-09-27
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Clayton County Public Schools
Department of Nutrition
Yetunde Alade
Phone: 6784790171 ex 160203
218 B Stockbridge Rd
Jonesboro GA 30236
Agency Email: yetunde.alade@clayton.k12.ga.us
Expiration Date: 2019-07-31
Sent to Facility: 2017-01-19
Sent to Provost: 2017-07-07
Sent to Legal:
Completed: 2017-07-17
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement
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Duluth Childrens Medicine
School of Nursing
James Lin
Phone: 678-878-2808
3500 Duluth Park Lane Suite 220
Duluth GA 30096
Agency Email: duluthcm@gmail.com
Expiration Date: 2023-03-31
Sent to Facility: 2023-03-08
Sent to Provost: 2020-04-06
Sent to Legal:
Completed: 2020-04-07
Requester Name: Lisa Williams
Document 1: ExpMar2023 DuluthChildrensMed
Document 2:
Document 3:
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Day League
School of Nursing
Phyllis Miller
Phone: 404-377-1429
204 Church Street
Decatur GA 30030
Agency Email: phyllis@dayleague.org
Expiration Date: 2026-03-31
Sent to Facility: 2020-03-26
Sent to Provost: 2020-05-13
Sent to Legal:
Completed: 2023-04-18
Requester Name: Lisa Williams
Document 1: Day League
Document 2:
Document 3:
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Transitional Care Physicians of Georgia, PC
School of Nursing
Amar Mohan
Phone: 770-904-3222
P. O. Box 5856
Atlanta GA 31107
Agency Email: amar.mohan@tcpamd.com
Expiration Date: 2023-03-31
Sent to Facility: 2023-08-08
Sent to Provost: 2020-08-18
Sent to Legal:
Completed: 2020-08-20
Requester Name: Lisa Williams
Document 1: ExpMar2023 TransitionalCarePhysGroupGa forProvost (002) - signed
Document 2:
Document 3:
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Atrium Health, Navicent - NS, OT, PT
Department of Physical Therapy
Sherry Haizlip
Phone: 478-201-6500
3351 Northside Drive,
Macon GA 31201
Agency Email: Haizlip.Sherry@NavicentHealth.org
Expiration Date: 2026-03-21
Sent to Facility: 2020-04-07
Sent to Provost: 2020-03-18
Sent to Legal:
Completed: 2023-04-26
Requester Name: Carla Huggins
Document 1: Final Expires April 2020
Document 2: Atrium Health, Navicent
Document 3:
Comment: Auto renewals for one year increments 5-25-26
NAVICENT HEALTH, INC. D/B/A ATRIUM HEALTH NAVICENT
Copy ptclinicaleducation@gsu.edu
4/7/20 to facility for final signature
Full Legal Name: The Medical Center of Central Georgia,
inc. dba The Medical Center, Navicent Health & Health
Services of Central Georgia, Inc. dba Navicent Health
Physician Group
11/22/19 never heard from T. White, sent to Carrie Braun
braun.carrie@navicenthealth.org
7/28/20 Sherry Haizlip Out of Office Reply indicates she
is out on medical leave. Sent to Leslie Johnson per
Haizlip
message.
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IJB Healthcare Services, PC
Byrdine F Lewis School of Nursing and Health Professions
Olugbemiga Osoba
Phone: 404-953-5348
4028 Holcomb Bridge Rd 204
Peachtree Corners GA 30092
Agency Email: drosoba@ijbhealthcare.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-06-15
Sent to Provost: 2019-08-22
Sent to Legal:
Completed: 2019-08-29
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Centro de Salud Familiar
School of Nursing
Eliseo Vallejo
Phone: 770-734-9920
5836 Buford Highway Suite C
Norcross GA 30071
Agency Email: centrodesaludfam@bellsouth.net
Expiration Date: 2020-02-29
Sent to Facility: 2017-02-15
Sent to Provost: 2017-03-15
Sent to Legal:
Completed: 2017-03-21
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Hamilton Health Care System
School of Nursing
Deidre Pierce
Phone: 706-272-6422
1200 Memorial Drive
Dalton GA 30720
Agency Email: dpierce@hhcs.org
Expiration Date: 2022-01-31
Sent to Facility: 2022-01-19
Sent to Provost: 2019-02-06
Sent to Legal:
Completed: 2019-02-25
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: facility requested changes be made to the document.
document sent to caroline lombard
renew 3/12/18
1/30/19 - Redlined version fwd to Legal for review. LYW
2/6/19 to provost for signature
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Primary Health Care Centers
School of Nursing
Melanie Forsythe
Phone: 706-620-4494
106 E. Withers Street
Lafayette GA 30728
Agency Email: forsythem@primaryhealthcarecenter.org
Expiration Date: 2020-02-29
Sent to Facility: 2017-02-15
Sent to Provost: 2017-02-21
Sent to Legal:
Completed: 2017-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Big Stride Therapy
Department of Occupational Therapy
Bernie Dewit
Phone: 678 665-2926
150 Foal Drive
Roswell GA 30076
Agency Email: bigstridetherapy@gmail.com
Expiration Date: 2027-01-31
Sent to Facility: 2022-09-21
Sent to Provost: 2024-03-14
Sent to Legal:
Completed: 2020-02-11
Requester Name: Karen McWaters
Document 1: exp jan 2023 ...213165318pdf
Document 2:
Document 3:
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Verras Pediatrics, P.C.
BFLCNHP
Maria Schumann
Phone: 770-491-1285
2007 Montreal Road Suite A
Tucker GA 30084
Agency Email: verraspeds@bellsouth.net
Expiration Date: 2023-02-28
Sent to Facility: 2023-02-02
Sent to Provost: 2020-04-24
Sent to Legal:
Completed: 2020-04-28
Requester Name: Lisa Williams
Document 1: VerrasPeds Apr2020 signed pdf
Document 2:
Document 3:
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Walker Therapy
Department of Occupational Therapy
Nicole Walker
Phone: 770 781 4899
78 Dawson Village Way N 140-153
Dawsonville GA 30534
Agency Email: walkertherapy@yahoo.com
Expiration Date: 2023-02-28
Sent to Facility: 2019-09-26
Sent to Provost: 2019-11-07
Sent to Legal:
Completed: 2019-11-07
Requester Name: Karen McWaters
Document 1: Final Expires February 2020
Document 2: Exp Feb 2023 doc...140328
Document 3:
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Childrens Therapy Works
Department of Occupational Therapy
Carlie Teschner
Phone: 770 754 0085
11660 Alpharetta Hwy 320
Roswell GA 30076
Agency Email: mary@childrenstherapyworks.com
Expiration Date: 2020-02-29
Sent to Facility: 2020-02-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: childrenstherapyworks@gmail.com; carlie.teschner@academyaba.com;
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Plus One Health Management
Department of Nutrition
Carrie Lieu
Phone: 646-312-6210
77 Water Street 1501
New York NY 10005
Agency Email: carrie.lieu@plusone.com
Expiration Date: 2023-02-29
Sent to Facility: 2019-12-19
Sent to Provost: 2020-01-16
Sent to Legal:
Completed: 2020-01-17
Requester Name: Jessica Todd
Document 1: Exp Feb 2023 ..PlusOneHealthMgmt...pdf
Document 2:
Document 3:
Comment: non-clinical
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Womens Health Associates Atlanta
BFLCNHP
Susan Holland-Roberts
Phone: 404-252-3898
980 Johnson Ferry Road NE Suite 720
Atlanta GA 30342
Agency Email: Susan.roberts-holland@unifiedhc.com
Expiration Date: 2025-02-28
Sent to Facility: 2017-03-23
Sent to Provost: 2017-05-17
Sent to Legal:
Completed: 2022-02-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Peter and Paul Community Services Inc.
Department of Occupational Therapy
Adam Pearson
Phone: 314-338-8166
6212 Wyoming St.
St. Louis MO 63118
Agency Email: apearson@ppcsinc.org
Expiration Date: 2020-03-31
Sent to Facility: 2022-07-19
Sent to Provost: 2017-07-26
Sent to Legal:
Completed: 2017-07-31
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Physicians Express Care
School of Nursing
Melissa Anepohl
Phone: 770-772-1830
11705 Jones Bridge Road Suit A201
Johns Creek GA 30005
Agency Email: Melissa@getexpresscare.com
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-17
Sent to Provost: 2017-03-27
Sent to Legal:
Completed: 2017-04-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Baybol Pediatrics
School of Nursing
Marta Nsue
Phone: 470-509-4648
5 Dunwoody Park Suite 113
Atlanta GA 30338
Agency Email: akinsola@baybolpediatrics.com
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-17
Sent to Provost: 2017-04-25
Sent to Legal:
Completed: 2017-04-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 3/1/2018 - This sit is not available for students. They
charge a fee.
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Sterling Learning Center
Perimeter College Department of Nursing
Sharonda Brown
Phone: 770-270-2068
4922 LaVista Road
Tucker GA 30084
Agency Email: sterlinglearing@gmail.com
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-17
Sent to Provost: 2017-03-24
Sent to Legal:
Completed: 2017-04-06
Requester Name: Brandi Pinckney
Document 1: view
Document 2:
Document 3:
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Sanus Medical One
School of Nursing
Pam Maloof
Phone: 404-252-7226
5885 Glenridge Drive Suite 250
Atlanta GA 30328
Agency Email: pam.maloof@sanusmedical.com
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-17
Sent to Provost: 2017-03-24
Sent to Legal:
Completed: 2017-04-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Site will not take a student after 2018 due
to commitment to Mercer U.
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Foundation Therapy Center
Department of Occupational Therapy
Beverly Stegman
Phone: 770-753-9195
6160 Peachtree Dunwoody Road Suite B 90
Atlanta GA 30328
Agency Email: Bsbrook@bellsouth.net
Expiration Date:
Sent to Facility: 2019-11-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: If possible, please expedite this request. If they can take
a Level 1 student, they would begin on Feb 17, 2020. -
Letitia Carelock lcarelock@gsu.edu
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Charleston Pediatric Rehabiliation
Department of Occupational Therapy
Michael Coyle
Phone: 843-364-5437
2070 Northbrook Blvd Suite B4
North Charleston SC 29406
Agency Email: mcoyle@4cpr.com
Expiration Date:
Sent to Facility: 2017-06-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: MOU emailed.
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HCTec
Byrdine F Lewis School of Nursing and Health Professions
Briana Skinner
Phone: 615-627-1014
5106 Maryland Way
Brentwood TN 37027
Agency Email: bskinner@hctec.com
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-23
Sent to Provost: 2017-05-01
Sent to Legal:
Completed: 2017-05-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Manna Treatment
Department of Nutrition
Tori Payton
Phone: 770-495-9775
965 Oakland Rd 3D
Lawrenceville GA 30044
Agency Email: vpayton@mannatreatment.com
Expiration Date: 2024-07-31
Sent to Facility: 2021-07-12
Sent to Provost: 2017-04-13
Sent to Legal:
Completed: 2021-07-2021
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: clinical agreement
This has expired but a new one with same information is
requested to re-start. Manna Scholarship Fund, Inc; DBA:
Manna Treatment
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TriStar Health System, Inc.
Lewis College of Nursing and Health Professions
Justin Laferty
Phone:
343 Franklin Road Suite 212
Brentwood TN 37027-5250
Agency Email: Justin.Laferty@hcahealthcare.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-26
Requester Name: Karen McWaters
Document 1: TriStar-Health
Document 2: ExpOct2022 TriStar Health 2020 2022 pdf
Document 3: ExpOct2022 TriStar Health 2020-2022 pdf
Comment: 4/17/20 J. Esha McTizik initiated renewal
8/30/23 - K McWaters initiated renewal
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Ridgeview Institute - dba Vest Monroe LLC
Byrdine F Lewis School of Nursing and Health Professions
Amy Alexander
Phone: 6786353500
709 Breedlove Drive
Monroe GA 30655
Agency Email: aalexander@ridgeviewmonroe.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-06-14
Sent to Provost: 2019-08-12
Sent to Legal:
Completed: 2022-04-25
Requester Name: Charlette DeLoach
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Please cc the following person on all correspondence,
Dr. Tamara Thompson
Email: tthompson@ridgeviewmonroe.com
Kimberly Hyatt CNO
8/9/19 Faith Connell sent MOU to Kyra Dunson for signature
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Center for Pediatric Wellness, P.C.
BFLCNHP
Elizabeth LeDuc
Phone: 404-389-1600
6000 Lake Forrest Dr. 110
Atlanta GA 30328
Agency Email: drelizabeth@centerforpediatricwellness.com
Expiration Date: 2022-05-31
Sent to Facility: 2022-04-21
Sent to Provost: 2019-07-05
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
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Clayton County Public Schools - Nursing Perimeter
Byrdine F Lewis School of Nursing and Health Professions
Angela Horrison-Collier
Phone: 770-473-2700
1058 Fifth Ave.
Jonesboro GA 30236
Agency Email: angela.horrison-collier@clayton.k12.ga.us
Expiration Date:
Sent to Facility: 2019-09-16
Sent to Provost: 2019-09-11
Sent to Legal: 2019-08-28
Completed:
Requester Name: Charlette DeLoach
Document 1:
Document 2:
Document 3:
Comment: This contract is for the purpose of conducting scoliosis
and hearing/vision screenings with Clayton County Board of
Health.
9/10/19 C. Lombard approved TERM edits, to provost for
signature
9/26/19 to facility for final signature.
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University Athletic Association, INC.
Department of Nutrition
Collier Perno
Phone: 352-275-6205
PO BOX 14485
Gainesville FL 32604-2485
Agency Email: collierp@gators.ufl.edu
Expiration Date: 2020-03-31
Sent to Facility: 2017-03-24
Sent to Provost: 2017-03-27
Sent to Legal:
Completed: 2017-04-14
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement
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Albert Johary, MD
BFLCNHP
Albert Johary
Phone: 770-730-8908
1320 Center Drive Suite 100
Dunwoody GA 30338
Agency Email: robin@albertjoharymd.com
Expiration Date: 2020-09-30
Sent to Facility: 2020-08-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Cartersville Pediatrics Associates
BFLCNHP
Joy Bell
Phone: 770-386-3011
958-A Joe Frank Harris Parkway SE Suite 101
Cartersville GA 30120
Agency Email: jbell@cartersvillepediatrics.com
Expiration Date: 2021-12-31
Sent to Facility: 2021-11-18
Sent to Provost: 2017-12-12
Sent to Legal:
Completed: 2017-12-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: complete
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Good News Clinics
BFLCNHP
Liz Coates
Phone: 770-503-1369
810 Pine Street
Gainesville GA 30501
Agency Email: lcoates@goodnewsclinics.org
Expiration Date: 2023-04-30
Sent to Facility: 2020-03-31
Sent to Provost: 2020-06-19
Sent to Legal:
Completed: 2020-07-01
Requester Name: Lisa Williams
Document 1: ExpApr2023 GoodNewsClinics forProvost (003) - signed
Document 2:
Document 3:
Comment: AllisonB@goodnewsclinics.org not deliverable 3/31/2020
6/20/20 - mailed to Liz Coates.LYW
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Atlanta Area School for the Deaf
Stacey Shapiro
Phone: 404-300-5899
800 N. Indian Creek Drive
Clarkston GA 30021
Agency Email: SShapiro@doe.k12.ga.us
Expiration Date:
Sent to Facility: 2017-04-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: MOU emailed.
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Community Friendship Incorporated
Byrdine F Lewis School of Nursing and Health Professions
Beth Boersma
Phone: 404-875-0381 ext 252
85 Renaissance Parkway, NE
Atlanta Ga 30308
Agency Email: bboersma@communityfriendship.org
Expiration Date: 2024-05-14
Sent to Facility: 2020-04-08
Sent to Provost:
Sent to Legal:
Completed: 2024-06-08
Requester Name: Carolyn Podolski
Document 1: Community Friendship Inc_exp_05-14-2024
Document 2:
Document 3:
Comment: Please include Shana Finks in the email when you send it
to the site: sfinks@gsu.edu. Carolyn uses them for Level
1 placements but Shana should be kept in the loop on its
status as well. Thanks! -Letitia
8/3/20 Followed up with facility as to status of the
contract
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Baylor Scott & White Institute of Rehab - Lakeway (BIR JV LLC)
Department of Physical Therapy
Debbie Belcher
Phone: 512-263-4513
2000 Medical Drive
Lakeway Texas 78734
Agency Email: debelcher@bswrehab.com
Expiration Date: 2018-06-26
Sent to Facility: 2018-06-19
Sent to Provost: 2018-06-28
Sent to Legal:
Completed: 2018-08-30
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: MOU emailed. Termination letter received 6-13-18 changing
the name from Vibra to Baylor.
6/28/18 received from legal, sent to clinic for signature.
MOU Complete, auto renews annually.
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Helpful Therapy Center
School of Nursing
Cherrell Thomas
Phone: 404-422-2628
2330 Scenic Highway Suite 225
Snellville GA 30078
Agency Email: cthomas@helpfultherapy.net
Expiration Date: 2026-04-30
Sent to Facility: 2020-03-30
Sent to Provost: 2020-06-16
Sent to Legal:
Completed: 2023-04-03
Requester Name: Lisa Williams
Document 1: ExpApr 2023 HelpfulTherapyCenter for provost signed pdf
Document 2:
Document 3:
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Northwest Georgia Medical Clinic
School of Nursing
Gina Lance
Phone: 706--291-0884
15 Riverbend Drive SW
Rome GA 30161
Agency Email: glance@nwgamedicalclinic.com
Expiration Date: 2026-07-31
Sent to Facility: 2017-04-19
Sent to Provost: 2017-04-24
Sent to Legal:
Completed: 2023-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Dr. David Kim, MD
School of Nursing
Feliciana Kim
Phone: 770-387-4512
491 E. Main Street
Cartersville GA 30121
Agency Email: felikim@comcast.net
Expiration Date: 2026-11-30
Sent to Facility: 2020-03-31
Sent to Provost:
Sent to Legal:
Completed: 2023-12-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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H.E.R.O. for Children, Inc.
Perimeter College Department of Nursing
Donna Drakes
Phone: 470-321-3102
580 West Crossville Road Suite 204
Roswell GA 30075
Agency Email: donna@heroforchildren.org
Expiration Date: 2020-04-30
Sent to Facility: 2017-04-19
Sent to Provost: 2017-04-20
Sent to Legal:
Completed: 2017-04-27
Requester Name: Brandi Pinckney
Document 1:
Document 2:
Document 3:
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Rome Womens Health Center
School of Nursing
Nicole Dupree
Phone: 776-234-7915
1608 Martha Berry Boulevard, NW
Rome GA 30161
Agency Email: rwhc1608@gmail.com
Expiration Date: 2020-04-30
Sent to Facility: 2017-04-19
Sent to Provost: 2017-06-20
Sent to Legal:
Completed: 2017-07-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Completed 7/18/17
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Caron Solutions
School of Nursing
Cheryl Knepper
Phone: 610-743-6487
150 Upper Hembree Road
Roswell GA 30076
Agency Email: CKnepper@caron.org
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:
Document 3:
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DeKalb-Gwinnett OB/GYN
School of Nursing
Rachel Tate
Phone: 770-446-4388
4045 Wetherburn Way
Norcross GA 30092
Agency Email: tatobg@gmail.com
Expiration Date: 2020-05-31
Sent to Facility: 2017-06-09
Sent to Provost: 2017-08-02
Sent to Legal:
Completed: 2017-08-09
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: MOU complete
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Childrens Healthcare Center, LLC
School of Nursing
Christy Mountain-Bonner
Phone: 478-412-6522
601 Fern Crest Drive Suite B
Sandersville GA 31082
Agency Email: christymountain@hotmail.com
Expiration Date: 2020-06-30
Sent to Facility: 2020-06-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Peachtree Pharmacy
Health Informatics
April Hang
Phone: 678 - 691-9079
5270 Peachtree Pkwy #114-A
Peachtree Corners Georgia 30092
Agency Email: April@peachtreerx.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-09
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
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Albany Area Primary Healthcare
BFLCNHP
Shantae Oliver
Phone: 229-439-7185
1512 W. 3rd Avenue
Albany GA 31707
Agency Email: soliver@sowega-ahec.org
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-13
Sent to Provost: 2018-02-15
Sent to Legal:
Completed: 2021-05-13
Requester Name: Lisa Williams
Document 1: Albany Area Primary Healthcare_exp03-31-2024
Document 2:
Document 3:
Comment: Colleen.Sullivan@aaphc.org contracts contact number 3-13-24
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North Georgia Audiology
Health Informatics
Deborah Woodward
Phone: 770-814-1260
4045 Johns Creek Parkway
Suwanee Georgia 30024
Agency Email: Deborah@ngaudiology.com
Expiration Date: 2021-01-31
Sent to Facility: 2018-01-24
Sent to Provost: 2018-01-25
Sent to Legal:
Completed: 2018-02-01
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: complete
|
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|
Athens Orthopedic Clinic
Physical Therapy
Heather Slonaker
Phone: 706-433-4074
1765 Old West Broad Street
Athens GA 30606
Agency Email: hslonaker@athensorthopedicclinic.com
Expiration Date: 2026-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-03-30
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Nurses Heart to Heart
School of Nursing
Anita Rich
Phone: 678-644-8159
POB 3565 Suite 950
Alpharetta GA 30023
Agency Email: anita@nhth.org
Expiration Date: 2018-12-31
Sent to Facility: 2018-10-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Renewal Initiated 10/11/2018
2/22/19 No longer need this renewed Per Lisa Williams
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For Hearts and Souls
School of Nursing
Kirk Milhoan
Phone: 555-555-1212
3 Adobe Grove
San Antonio TX 78239
Agency Email: none@none.com
Expiration Date: 2018-12-31
Sent to Facility: 2018-10-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 10/11/2018 Renewal Initiated.
2/22/19 No longer need this renewed per Lisa Williams
|
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VA Medical Center (Atlanta)/Southeast Network (VISN 7)
Health Informatics
Jennifer Bonds
Phone: 404-321-6111 ext. 2399
1670 Clairmont Road
Decatur Georgia 30033
Agency Email: Jennifer.Bonds@va.gov
Expiration Date: 2027-08-30
Sent to Facility: 2018-01-24
Sent to Provost: 2018-01-26
Sent to Legal:
Completed: 2018-02-09
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: complete
|
| |
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|
Family Physicians of Evans
School of Nursing
Beverly Parnell
Phone: 776-854-2160
465 N. Belair Road Unite 1C
Evans GA 30809
Agency Email: bparnell@fpevans.com
Expiration Date: 2021-03-31
Sent to Facility: 2018-03-05
Sent to Provost: 2018-03-06
Sent to Legal:
Completed: 2018-03-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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|
Covenant Care Pediatrics
BFLCNHP
Danielle Eidson
Phone: P: 770-389-4543
130 Medical Way Suite B
Stockbridge GA 30281
Agency Email: ppulliam@covenantcarepediatrics.com
Expiration Date: 2021-02-28
Sent to Facility: 2021-02-03
Sent to Provost: 2018-03-05
Sent to Legal:
Completed: 2018-03-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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All Care Medical Associates
BFLCNHP
Tonya House
Phone: 478-225-9001
1860 Watson Boulevard
Warner Robins GA 31093
Agency Email: allcaretonyah@gmail.com
Expiration Date: 2021-02-28
Sent to Facility: 2018-02-20
Sent to Provost: 2018-03-07
Sent to Legal:
Completed: 2018-03-15
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 2/4/21 - declined to renew contract.
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|
AG Rhodes Health and Rehab Center - Marietta (Nursing)
BFLCNHP
Mary Helton
Phone: 770-427-8727 x120
900 Wylie Road
Marietta GA 30067
Agency Email: mhelton@agrhodes.org
Expiration Date: 02/29/2024
Sent to Facility: 2018-02-14
Sent to Provost: 2018-07-06
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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|
Gwinnett Hospital System, Inc. - ACNP
School of Nursing
Jennifer Brooks
Phone: 678-312-3431
100 Medical Center Boulevard Suite 115
Lawrenceville GA 30046
Agency Email: JBrooks@gwinnettmedicalcenter.org
Expiration Date: 2022-05-14
Sent to Facility: 2019-05-09
Sent to Provost:
Sent to Legal:
Completed: 2019-05-31
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: For Acute Care program
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Olansky Dermatology Associates
BFLCNHP
Elaine Benuck
Phone: 404-355-5484
3379 Peachtree Road
Atlanta GA 30346
Agency Email: ebenuck@olanskydermatology.com
Expiration Date: 2024-08-31
Sent to Facility: 2018-02-20
Sent to Provost: 2018-02-22
Sent to Legal:
Completed: 2021-09-15
Requester Name: Lisa Williams
Document 1: Olansky Dermatology Associate
Document 2:
Document 3:
Comment: 2/3/2021 - Declined to renew.
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Life Cycle Pediatrics, LLC
BFLCNHP
Dorsey Norwood
Phone: 404-766-8371
2739 Felton Drive
East Point GA 30344
Agency Email: dorseynorwood@earthlink.net
Expiration Date: 2021-02-28
Sent to Facility: 2021-03-11
Sent to Provost: 2018-04-17
Sent to Legal:
Completed: 2018-04-25
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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United States Olympic Committee
Department of Nutrition
Rachel Austin
Phone: 1-719-352-6547
1 Olympic Plaza
Colorado springs Co 80909
Agency Email: alicia.kendig@usoc.org
Expiration Date: 2019-04-01 annual renewal
Sent to Facility: 2018-03-01
Sent to Provost: 2018-05-10
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Please send MOU to both Alicia and Rachel.
mou emailed
5/10/18 J. Todd sent to Rachel for signature
annual renews per section 9 page 3
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Grant Park Clinic
BFLCNHP
Claudia Cano
Phone: 404-627-4259
1340 Boulevard SE
Atlanta GA 30315
Agency Email: cc@grantparkclinic.org
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-03-30
Sent to Legal:
Completed: 2018-04-11
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Clinical Services Inc. d/b/a Ethica Health & Retirement Communities
School of Nursing
Chasity Jenkins
Phone: 478-405-9000
1005 Boulder Drive
Gray GA 31032
Agency Email: CSJenkins@sas-ga.org
Expiration Date: 2019-12-31
Sent to Facility: 2018-02-27
Sent to Provost:
Sent to Legal:
Completed: 2018-05-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 2/27 Caroline reviewing contract. LYW
8/21/18 Sent to Connie Stoval at facility for signature
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SenseAbilities
Department of Occupational Therapy
Kristi Rigdon
Phone: 478-333-6363
905 Arrowhead Trail
Warner Robins Ga 31088
Agency Email: krigdon@senseabilities.net
Expiration Date: 2024-02-28
Sent to Facility: 2018-03-02
Sent to Provost: 2018-04-19
Sent to Legal:
Completed: 2024-03-06
Requester Name: Karen McWaters
Document 1: SenseAbilities_exp_3-30-2024
Document 2:
Document 3:
Comment: Partially executed agreement - 03-29-21
final copy uploaded 04-08-2021
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Athens Pulmonary & Sleep Medicine
Byrdine F Lewis School of Nursing and Health Professions
Hallie Epps
Phone: 706-549-5560
3320 Old Jefferson Road
Athens GA 30607
Agency Email: hepps@athenspulmonary.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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The Pediatric Clinic of Stone Mountain, LLC
BFCNHP
April Abbott
Phone: 404-296-3800
5405 Memorial Drive
Stone Mountain GA 30083
Agency Email: april_c@the-pediatric-center.com
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-13
Sent to Provost: 2018-05-04
Sent to Legal:
Completed: 2021-04-07
Requester Name: Lisa Williams
Document 1: The Pediatric Clinic of Stone Mountain LLC_exp_3-31-24
Document 2:
Document 3:
Comment: email address is not working 3-13-2024
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Chestatee Emergent Medical Care
BFLCNHP
April Duff
Phone: 706-265-6866
2395 Thompson Road
Dawsonville GA 30534
Agency Email: chestateeemergentcare@yahoo.com
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-04-12
Sent to Legal:
Completed: 2018-04-16
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Greater Atlanta Pediatrics, PC
BFLCNHP
Saad Hammid
Phone: 770-322-6161
5243 Snapfinger Woods Drive Suite 104
Decatur GA 30035
Agency Email: greateratlantaped@gmail.com
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-03-22
Sent to Legal:
Completed: 2018-04-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Conyers Internal Medicine, LLC
School of Nursing
Faye Cofer
Phone: 770-918-2555
1805 Honey Creek Commons Suite C
Conyers GA 30013
Agency Email: fcofer.shakoor@yahoo.com
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-03-22
Sent to Legal:
Completed: 2018-04-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Cobb County School District-OT
Department of Occupational Therapy
Elizabeth Poulsen
Phone: 678-581-6801
514 Glover Street
Marietta Ga 30060
Agency Email: elizabeth.poulsen@cobbk12.org
Expiration Date: 03/31/2024
Sent to Facility: 2018-03-23
Sent to Provost: 2018-04-20
Sent to Legal:
Completed: 2018-05-01
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Need to renew as expires during OT rotation in spring 2024 - Karen McWaters
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North Fulton OB-GYN
Byrdine F Lewis School of Nursing and Health Professions
Lisa Vinokur
Phone: 770-754-4445
3400C Old Milton Parkway Suite 585
Alpharetta GA 30342
Agency Email: 1babydoc@bellsouth.net
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: North Fulton OBGYN_02-01-21
Document 2:
Document 3:
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Grayson Pediatrics
BFLCNHP
Julie Opeka
Phone: 678-381-2630
297 Cooper Road
Loganville GA 30052
Agency Email: julie@graysonpediatrics.com
Expiration Date: 2024-04-30
Sent to Facility: 2021-03-09
Sent to Provost:
Sent to Legal:
Completed: 2021-05-14
Requester Name: Lisa Williams
Document 1: Grayson Pediatrics
Document 2:
Document 3:
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Professional Healthcare Consultants
School of Nursing
Roy Harrell
Phone: 404-849-1611
2292 Whiteoak Drive SE
Smyrna GA 30080
Agency Email: rlhj74@gmail.com
Expiration Date: 2021-03-31
Sent to Facility: 2021-02-12
Sent to Provost: 2018-04-13
Sent to Legal:
Completed: 2018-05-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Southeast Network (VISN 7) - Clinical Health Informatics Graduate Certificate
Health Informatics
Jennifer Bonds
Phone: 678-682-3907
1670 Clairmont Road
Decatur Georgia 30030
Agency Email: Jennifer.Bonds@va.gov
Expiration Date: 2028-03-08
Sent to Facility:
Sent to Provost: 2018-06-22
Sent to Legal:
Completed: 2018-08-24
Requester Name: Dr.Cedric Truss
Document 1: view
Document 2:
Document 3:
Comment: 8/24/18 Completed. The VA requests that we use their
affiliation agreement
and a new one has to be in place for each program. The
BIS Health Informatics program had an agreement
established in Jan 2018. Now the new agreement is for
the Graduate Certificate in Clinical Health Informatics.
VA Affiliation
Paperwork will be provided to K. Nowviskie on 4/2/2018 to
route to legal, etc. Thanks, C. Truss
we can not route items directly to legal. We have to get
approval from Caroline Lombard first.
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Colon and Digestive Health Specialists, LLC
BFLCNHP
Alexis Hall
Phone: 770-922-7000
1805 Honey Creek Commons
Conyers GA 30013
Agency Email: aleha.eec@gmail.com
Expiration Date: 2021-04-30
Sent to Facility: 2021-03-09
Sent to Provost: 2018-04-25
Sent to Legal:
Completed: 2018-05-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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North Atlanta Pediatrics Associates
BFLCNHP
Dee Schultz
Phone: 404-256-3178
1100 Lake Hearn Drive Suite 100
Atlanta GA 30342
Agency Email: dschultz@northatlantapeds.com
Expiration Date: 2021-04-30
Sent to Facility: 2021-03-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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GiGis Playhouse
Howie Rosenberg
Phone: 404 246-0121
549 Amsterdam Ave suite 1
Atlanta Ga 30306
Agency Email: hrosenberg@gigisplayhouse.org
Expiration Date: 2025-05-31
Sent to Facility: 2018-04-06
Sent to Provost: 2018-05-03
Sent to Legal:
Completed: 2022-06-02
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: complete.
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Silver Spoons Nutrition
Department of Nutrition
Margot Witteveen
Phone: 404-394-8272
1370 Iverson Street
atlanta ga 30307
Agency Email: margot@silverspoonsnutrition.co
Expiration Date:
Sent to Facility: 2018-04-11
Sent to Provost: 2018-04-12
Sent to Legal:
Completed: 2018-05-01
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical Agreement
4/11/18 - Emailed agreement to M. Witteveen
4/12/18 - Received signed agreement
4/12/18 - Sent to Legal
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Prevent Blindness Georgia
Health Informatics
DeAndria Nichols
Phone: 404-266-2895
739 West Peactree Street NW 200
Atlanta GA 30308
Agency Email: dnichols@pbga.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Dr.Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: 4/18/18 Emailed to D. Nichols .Kelli
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Pediakare
School of Nursing
Felicia Heard
Phone: 770-683-3739
1111 Bullsboro Road Suite 6 & 7
Newnan GA 30265
Agency Email: fle501@jagmail.southalabama.edu
Expiration Date: 2021-05-31
Sent to Facility: 2018-04-13
Sent to Provost: 2018-04-30
Sent to Legal:
Completed: 2018-05-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 5/18/18 - Sent final copy to all parties via email.
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The Renfrew Center
BFLCNHP
Paula Gayfield
Phone: 678-328-4100
50 Glenlake Parkway Suite 120
Atlanta GA 30328
Agency Email: pgayfield@renfrewcenter.com
Expiration Date: 2021-11-30
Sent to Facility: 2023-03-23
Sent to Provost: 2019-02-06
Sent to Legal:
Completed: 2019-02-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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MD Logic, Inc
Health Informatics
Laura Pruett
Phone: 770-497-1560
2170 Satellite Blvd 435
Duluth GA 30097
Agency Email: lpruett@mdlogic.com
Expiration Date: 2021-04-30
Sent to Facility: 2018-04-18
Sent to Provost: 2018-04-24
Sent to Legal:
Completed: 2018-05-18
Requester Name: Dr.Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: 5/18/18 Final copy sent to all parties via email
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David A Fields Family Care
BFLCNHP
Victoria Gaddis
Phone: 770-554-0399
96 Tara Commons Drive
Loganville GA 30052
Agency Email: vgaddis@fieldsfamilycare.com
Expiration Date: 2024-04-30
Sent to Facility: 2024-04-11
Sent to Provost: 2018-05-10
Sent to Legal:
Completed: 2021-03-17
Requester Name: Lisa Williams
Document 1: David A Fields Family Care
Document 2:
Document 3:
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Pediatric Associates
School of Nursing
Kevin Johnson
Phone: 770-965-6894
2695 Old Winder Highway 200
Braselton GA 30517
Agency Email: kjohnson@pediassoc.com
Expiration Date: 2021-04-30
Sent to Facility: 2018-04-20
Sent to Provost: 2018-05-14
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 4/20/18 MOU emailed .kelli
5/14/18 to legal
6/25/18 Legal request resend.
8/8/18 emailed complete MOU to all parties
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St. Clair Pediatrics
School of Nursing
Ginny Peter
Phone: 618-624-9970
4941 Benchmark Centre Drive Suite 100
Swansea IL 62226
Agency Email: ginmin11@gmail.com
Expiration Date: 2021-05-31
Sent to Facility: 2018-04-20
Sent to Provost: 2018-05-02
Sent to Legal:
Completed: 2018-05-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 4/20/18 MOU emailed .kelli
5/2/18 Sent to Legal
5/18/18 Sent final copies to all parties via email.
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Our Kids Pediatrics
BFLCNHP
Angela Reese
Phone: 706-886-1309
154 W. Tugalo Street
Toccoa GA 30577
Agency Email: rkids154@gmail.com
Expiration Date: 2021-04-30
Sent to Facility: 2021-03-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Nuestros Ninos Our Kids Pediatrics, Inc
BFLCNHP
Carolyn Regan
Phone: 770-732-6007
777 Franklin Gateway SE
Marietta GA 30067
Agency Email: cregan@childrenscvm.com
Expiration Date: 2024-05-31
Sent to Facility: 2024-04-11
Sent to Provost: 2018-05-14
Sent to Legal:
Completed: 2021-05-04
Requester Name: Lisa Williams
Document 1: Nuestros Ninos Our Kids_exp_05-31-2024
Document 2:
Document 3:
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University of Texas at Arlington
Perimeter College Department of Nursing
Sarah Baker
Phone: 817-995-2852
Po box 19407
Arlington Texas 76019
Agency Email: Sjbaker@uta.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Greta Baldwin Mason
Document 1:
Document 2:
Document 3:
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Healthy Weight Coaching
Department of Nutrition
Julie Taube
Phone: 6786126613
165 West Weiuca Rd
Atlanta Georgia 30342
Agency Email: julie@healthyweightcoaching.com
Expiration Date: 2024-05-31
Sent to Facility: 2018-05-03
Sent to Provost: 2018-05-07
Sent to Legal:
Completed: 2021-04-16
Requester Name: Jessica Todd
Document 1: view
Document 2: Healthy Weight Coaching_exp_05-31-2024
Document 3:
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Sharp Healthcare
Department of Occupational Therapy
Debbie Dickie
Phone: 858 499-5369
7901 Frost St
San Diego CA 92123
Agency Email: Debbie.Dickie@sharp.com
Expiration Date: 2021-08-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-13
Requester Name: Shana Finks
Document 1: Sharp Healthcare_exp_8-30-2021
Document 2:
Document 3:
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Curtis V. Cooper Primary Health Care
School of Nursing
Christine Ferrelle
Phone: 912-527-1000
106 E. Broad Street
Savannah GA 31401
Agency Email: cferrelle@cvcphc.com
Expiration Date: 2021-05-31
Sent to Facility: 2021-04-07
Sent to Provost:
Sent to Legal:
Completed: 2018-07-24
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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| |
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Forte Family Practice
School of Nursing
Valerie Maldonado
Phone: 702-240-8646
9010 W Cheyenne Avenue
Las Vegas NV 89120
Agency Email: checkingalval@yahoo.com
Expiration Date: 2021-05-31
Sent to Facility: 2018-05-14
Sent to Provost: 2018-05-15
Sent to Legal:
Completed: 2018-05-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 5/14/18 MOU emailed
5/15/18 to Legal
5/31/18 final copy sent to all parties via email
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Georgia Psychiatry & Sleep
BFLCNHP
Happy Porecha
Phone: (770) 438-1799
1314 Concord Road
Smyrna GA 30080
Agency Email: happy@mindandsleep.com
Expiration Date: 2024-06-30
Sent to Facility: 2018-07-03
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2021-07-06
Requester Name: Lisa Williams
Document 1: view
Document 2: Georgia Psychiatry & Sleep
Document 3:
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Old 4th Ward Pediatrics
BFLCNHP
Tennisha Williams
Phone: 404-525-0633
285 Boulevard NE Suite 235
Atlanta GA 30312
Agency Email: info@o4wpediatrics.com
Expiration Date: 2024-05-31
Sent to Facility: 2018-05-04
Sent to Provost: 2018-08-14
Sent to Legal:
Completed: 2021-09-02
Requester Name: Lisa Williams
Document 1: Old 4th Ward Pediatrics
Document 2: Old 4th Ward Pediatrics
Document 3:
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Jonesboro Pediatrics
BFLCNHP
Sharon Bryan-Grant
Phone: 770-478-9240
236 Arrowhead Boulevard
Jonesboro GA 30236
Agency Email: fanfare1@bellsouth.net
Expiration Date: 2021-05-31
Sent to Facility: 2021-04-07
Sent to Provost: 2018-05-15
Sent to Legal:
Completed: 2018-05-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Alcovy Internal Medicine
BFLCNHP
Melissa Hendricks
Phone: 770-267-6565
517 Great Oaks Drive Suite 102
Monroe GA 30655
Agency Email: hendrm@windstream.net
Expiration Date: 2021-05-31
Sent to Facility: 2021-04-07
Sent to Provost: 2018-07-12
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment:
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The Counseling and Training Center, Inc.
BFLCNHP
Amanda Dean
Phone: 478-953-0667
504 Osigian Boulevard Suite 1
Warner Robins GA 31088
Agency Email: adean@thecounselingandtrainingcenter.com
Expiration Date: 2021-06-30
Sent to Facility: 2018-06-28
Sent to Provost: 2018-07-12
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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| |
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Camp Kudzu
School of Nursing
Anna Albritton
Phone: 404-250-1811 x27
5885 Glenridge Drive Suite 160
Atlanta GA 30328
Agency Email: aalbritton@campkudzu.org
Expiration Date:
Sent to Facility: 2018-05-30
Sent to Provost: 2018-06-07
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Camp Kudzu
Document 2:
Document 3:
Comment: 6/7/18 to Legal
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| |
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Sunflower Pediatrics LLC
BFLCNHP
Denise Vaz
Phone: 470-589-7555
5422 Highway 2 Suite 203
Sugar Hill GA 30518
Agency Email: Sunflowercpnp@gmail.com
Expiration Date: 2021-05-31
Sent to Facility: 2021-04-07
Sent to Provost:
Sent to Legal:
Completed: 2018-06-06
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 5/28/21 - the practice does not want to renew at this
time.LYW
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StrongTower Behavioral Healthcare, LLC
BFLCNHP
Garnetta Peterson
Phone: 678-265-8361
3750 Palladian Village Drive Suite 110
Marietta GA 30066
Agency Email: admin@strongtowerclinics.com
Expiration Date: 2021-05-31
Sent to Facility: 2021-04-07
Sent to Provost: 2018-05-22
Sent to Legal:
Completed: 2018-06-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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GOODR
Department of Nutrition
Lynnette McKissic
Phone: 404-261-0211
384 Northyards Blvd. Building 100
Atlanta Georgia 30313
Agency Email: lynette@goodr.co
Expiration Date: 2021-06-30
Sent to Facility: 2018-05-30
Sent to Provost: 2018-07-09
Sent to Legal:
Completed: 2018-08-02
Requester Name: jessica todd
Document 1: view
Document 2:
Document 3:
Comment: Non clinical agreement
8/8/18 emailed complete to all parties
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| |
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Perimeter Pediatrics
School of Nursing
Jane Wu
Phone: 770-458-3383
3020 Mercer University Drive
Atlanta GA 30341
Agency Email: perimeterpediatrics@gmail.com
Expiration Date: 2021-07-31
Sent to Facility: 2021-06-17
Sent to Provost: 2018-07-18
Sent to Legal:
Completed: 2018-08-02
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment:
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| |
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TriStar Family Practice at the Crossings
School of Nursing
Dianne Neely
Phone: 615-731-8390
5380 Hickory Hollow Parkway Suite 100
Antioch TN 37013
Agency Email: Jennifer.shuler@hcahealthcare.com
Expiration Date: 2021-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2018-09-07
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 7/2 - to Legal for review. LYW
9/14/18 received from legal, sent to all parties
|
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Gwinnett Hospital System, Inc. ACNP_Dawit Antonios MD
School of Nursing
Jennifer Brooks
Phone: 678-312-3431
1000 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: JBrooks@gwinnettmedicalcenter.org
Expiration Date: 2020-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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| |
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Gwinnett Hospital System, Inc. ACNP_Neeta Sukthanker MD
School of Nursing
Jennifer Brooks
Phone: 678-312-3431
1000 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: JBrooks@gwinnettmedicalcenter.org
Expiration Date: 2019-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Eagles Landing Family Practice
School of Nursing
Missy Cain
Phone: 678-774-0430
1502 West 3rd Street
Jackson GA 30233
Agency Email: mcain@elfp.com
Expiration Date: 2024-07-31
Sent to Facility: 2018-07-31
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2021-08-04
Requester Name: Lisa Williams
Document 1: Eagles Landing Family Practice
Document 2: Eagles Landing Family Practice
Document 3:
Comment:
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Meals on Wheels Atlanta
Department of Nutrition
Charlene Crusoe-Ingram
Phone: 404-351-3889
1705 Commerce Drive NW
Atlanta Ga 30318
Agency Email: ccrusoeIngram@mealsonwheelsatlanta.org
Expiration Date: 2021-06-30
Sent to Facility: 2018-07-31
Sent to Provost: 2018-08-13
Sent to Legal:
Completed: 2018-09-07
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical agreement
7/31/18 MOU emailed
8/13/18 To legal, 8/29/18 followed up with legal
9/17/18 received fr legal, emailed to all parties
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Atlanta Clinical Care
BFLCNHP
Simone Flack
Phone: 404-459-0002
5673 Peachtree Dunwoody Road Suite 330
Atlanta GA 30342
Agency Email: sflack@atlclinicalcare.com
Expiration Date: 2024-07-31
Sent to Facility: 2018-07-31
Sent to Provost: 2018-08-20
Sent to Legal:
Completed: 2021-06-25
Requester Name: Lisa Williams
Document 1: Atlanta Clinical Care_8-31-2024
Document 2:
Document 3:
Comment: 8/28/18 complete, emailed to all parties
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Sabrina Lancaster NP-C Inc
BFLCNHP
Sabrina Lancaster
Phone: 706-938-4567
503 West Gordon Street
Thomaston GA 30286
Agency Email: sabrinalancasternp@gmail.com
Expiration Date: 2025-07-31
Sent to Facility: 2018-08-02
Sent to Provost: 2018-08-06
Sent to Legal:
Completed: 2022-06-10
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: Thomaston GA and Manchester GA
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Conyers Pediatrics
BFLCNHP
Sonia Brown
Phone: 678-750-1403
7138 Highway 212
Covington GA 30016
Agency Email: conyerspediatrics@gmail.com
Expiration Date: 2021-07-31
Sent to Facility: 2021-06-17
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2018-09-07
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Decatur Center for Nursing & Healing, LLC
Byrdine F Lewis School of Nursing and Health Professions
Betsy Hill
Phone: (678) 365-3032
2722 North Decatur Road
Decatur GA 30033
Agency Email: bhill@decaturnursing.com
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2026-02-24
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: Manorcare changed ownership and the new name is Decatur Center
for Nursing and Healing - A new affiliation is warranted.
2/16/2023
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Peachtree City Urgent Care
BFLCNHP
Troy Faulkenberry
Phone: 404-487-2273
8 Eastbrook Bend Suite B
Peachtree City GA 30269
Agency Email: a_diver22@yahoo.com
Expiration Date: 2021-07-31
Sent to Facility: 2021-06-17
Sent to Provost: 2018-08-13
Sent to Legal:
Completed: 2018-09-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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The Task Force for Global Health-Public Health Informatics Institute
Health Informatics
Vivian Singletary
Phone: (404) 592-1419
325 Swanton Way
Atlanta GA 30030
Agency Email: vsingletary@taskforce.org
Expiration Date:
Sent to Facility: 2018-10-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Cedric Truss
Document 1:
Document 2:
Document 3:
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Diverse Therapy inc.
Department of Occupational Therapy
Michelle Tomlinson
Phone: 678-471-3841
5408 Park Circle
Stone Mountain Ga 30083
Agency Email: mtomlinson@diversetherapy.com
Expiration Date: 2024-08-31
Sent to Facility: 2024-04-10
Sent to Provost: 2018-08-06
Sent to Legal:
Completed: 2021-08-21
Requester Name: Karen McWaters
Document 1: Diverse Therapy inc
Document 2:
Document 3:
Comment: 8/6/18 to Legal
8/17/18 Complete. Emailed to all parties
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Diverse Therapy inc.
Department of Occupational Therapy
Michelle Tomlinson
Phone: 678-471-3841
5408 Park Circle
Stone Mountain Ga 30083
Agency Email: mtomlinson@diversetherapy.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: Thanks!
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Childrens Therapy Center of Columbia
Department of Occupational Therapy
Madeline Rosewag
Phone: 4109978081
10015 Old Columbia Road, Suite G 118
Columbia Maryland 21046
Agency Email: ctcofcolumbia@yahoo.com
Expiration Date: 2021-07-31
Sent to Facility: 2022-07-13
Sent to Provost: 2018-10-11
Sent to Legal:
Completed: 2018-10-26
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
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Physicians Pointe
Byrdine F Lewis School of Nursing and Health Professions
Brenda Schmitt
Phone: 770-339-5999
1925 Old Peachtree Rd NE
Lawrenceville GA 30043
Agency Email: admin@physicianspointe.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Creative Therapy Works, LLC
Department of Occupational Therapy
Christine Giles
Phone: 470-545-6228
1218 Rockbridge Road SW
Stone Mountain GA 30087
Agency Email: ctwslp@icloud.com
Expiration Date:
Sent to Facility: 2019-07-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Friends of Refugees - OT
School of Nursing
Jennifer Green
Phone: 4043230260
5140 Memorial Dr.
Stone Mountain Ga 30083
Agency Email: jennifer@friendsofrefugees.com
Expiration Date:
Sent to Facility: 2018-08-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: 8/8/18 MOU emailed
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Jewish Family & Career Services of Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Mikki Hollinger
Phone: 7706779347
4549 Chamblee Dunwoody Rd,
Atlanta Ga 30338
Agency Email: mhollinger@jfcsatl.org
Expiration Date: 2024-04-30
Sent to Facility: 2018-08-14
Sent to Provost:
Sent to Legal:
Completed: 2021-05-20
Requester Name: Carolyn Podolski
Document 1: Jewish Family and Career Services of Atlanta
Document 2: Jewish Family and Career Center of
Document 3:
Comment: 8/14/18 non-clinical agreement emailed
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Vertex PT Specialists
Department of Physical Therapy
Kyle Thibodeaux
Phone: 803-227-3753
3541 Dreher Shoals Rd. Suite 3
Irmo SC 29063
Agency Email: brandon@vertexpt.com
Expiration Date: 2021-08-31
Sent to Facility: 2024-02-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Please cc ptclinicaleducation@gsu.edu
brandon@vertexpt.com
kyle@vertexpt.com receives an email delivery error message
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Board of Education of the City of Decatur
Department of Nutrition
Ana Kucelin
Phone: 404-371-3601
215 Electric Ave
Decatur GA 30030
Agency Email: akucelin@csdecatur.net
Expiration Date: 2019-09-30
Sent to Facility: 2018-09-27
Sent to Provost: 2018-11-27
Sent to Legal:
Completed: 2018-12-17
Requester Name: Jessica Todd
Document 1: BOE City of Decatur Final
Document 2:
Document 3:
Comment: 8/16/18 MOU Emailed
9/26/18 Facility asked for name change from Decatur City
Schools to Board of Education of the City of Decatur.
9/27/18 MOU emailed back to facility with changes
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Barnesville Urgent Care and Family Practice
Byrdine F Lewis School of Nursing and Health Professions
Angie Bennett
Phone: 770-872-3663
522 Greenwood Street Suite A
Barnesville GA 30204
Agency Email: Abenn001@yahoo.com
Expiration Date: 2021-08-31
Sent to Facility: 2021-11-18
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2018-09-07
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: 8/16/18 MOU Emailed
8/29/18 to Legal
9/17/18 received from legal, emailed to all parties
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Metro Health & Wellness
Byrdine F Lewis School of Nursing and Health Professions
Kirstie Cunningham
Phone: 470-203-1856
2950 Stone Hogan Connector Building 3 - Suite B
Atlanta GA 30331
Agency Email: metrohealthandwellness@gmail.com
Expiration Date: 2021-08-31
Sent to Facility: 2021-07-21
Sent to Provost: 2018-09-17
Sent to Legal:
Completed: 2018-09-18
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment:
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Marcus Jewish Community Center of Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Ashley Cohen
Phone: 678-812-3861
5342 Tilly Mill Rd
Atlanta Ga 30338
Agency Email: ashley.cohen@atlantajcc.org
Expiration Date: 2021-08-31
Sent to Facility: 2021-07-02
Sent to Provost: 2018-08-29
Sent to Legal:
Completed: 2018-09-07
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: The signature name will be:
Janice Wolf, Chief Financial & Administrative Officer
Marcus Jewish Community Center of Atlanta
8/17/18 MOU Emailed - 8/29/18 to Legal
9/17/18 received from legal, emailed all parties
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Oscar Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Ike Oneyekaba
Phone: 470-355-2340
3375 Memorial Drive
Decatur GA 30032
Agency Email: info@oscarmedicalcenter.com
Expiration Date: 2021-08-31
Sent to Facility: 2021-07-21
Sent to Provost: 2018-09-12
Sent to Legal:
Completed: 2018-09-18
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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FOX Rehabilitation - OT
Department of Occupational Therapy
Brett Herman
Phone: 877 407 3422 x5035
7 Carnegie Plaza NJ
Cherry Hill NJ 08003
Agency Email: brett.herman@foxrehab.org
Expiration Date: 2021-08-31
Sent to Facility: 2018-11-02
Sent to Provost: 2018-10-24
Sent to Legal:
Completed: 2018-11-21
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
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Douglas County School Systems
Department of Nutrition
Danielle Freeman
Phone: 770-651-2300
9030 Hwy 5
Douglasville Ga 30134
Agency Email: danielle.freeman@dcssga.org
Expiration Date:
Sent to Facility: 2022-01-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: jessica todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical covers all schools
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The Atlanta Back Clinic
Department of Physical Therapy
Matthew Underwood
Phone: 770-491-6004
1841 Montreal Road Suite 110
Tucker GA 30084
Agency Email: info@atlantabackclinic.com
Expiration Date: 2021-08-31
Sent to Facility: 2021-04-01
Sent to Provost:
Sent to Legal:
Completed: 2018-09-18
Requester Name: Carla Huggins
Document 1: The Atlanta Back Clinic
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu on communication
Resent email 7/10/23
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ManorCare Rehabilitation Center -Decature
Byrdine F Lewis School of Nursing and Health Professions
Betsy Hill
Phone: 678.365.3032
2722 North Decatur Road
Decatur GA 30033
Agency Email: Elizabeth.hill@hcr-manorcare.com
Expiration Date: 2025-06-03
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 204-06-30
Requester Name: Anne Cadet-Baker
Document 1: ManorCare Rehabilitation Center_exp 06-03-2025
Document 2:
Document 3:
Comment: Contract Start date 06-04-2021 with a 4 year term. Exp.
date 06-03-2025 agreement completed 06-30-2021
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Pathways Transition Programs, Inc
Byrdine F Lewis School of Nursing and Health Professions
Lee Gobbel
Phone: 404.378.2300
120 East Trinity Place
Decatur GA 30030
Agency Email: lgobbel@pathwaystp.com
Expiration Date: 2021-08-31
Sent to Facility: 2021-07-21
Sent to Provost: 2018-09-14
Sent to Legal:
Completed: 2018-09-27
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Physicians Care Centers of Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Natasha Williamson
Phone: 404-501-7940
285 Boulevard NE Suite 435
Atlanta GA 30312
Agency Email: tashawillie@hotmail.com
Expiration Date:
Sent to Facility: 2018-09-05
Sent to Provost: 2018-09-12
Sent to Legal:
Completed: 2018-10-26
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Atlanta VA Health Care System - SE Network(VISN 7) - OT
Department of Occupational Therapy
James McElrath
Phone: (404) 321-6111 ext 2034
1670 Clairmont Road
Decatur 30033 GA 30033
Agency Email: james.mcelrath@va.gov
Expiration Date: 2028-09-27
Sent to Facility: 2018-11-20
Sent to Provost: 2018-10-15
Sent to Legal:
Completed: 2018-10-26
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: Complete
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Correct Health
Byrdine F Lewis School of Nursing and Health Professions
Linda John
Phone: 770.692.4750
3384 Peachtree Road Suite #700
Atlanta GA 30326
Agency Email: linda.john@correcthealth.org
Expiration Date:
Sent to Facility: 2018-09-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/13/18 MOU emailed
1/8/19 facilitys edits were sent to wrong email. Sent to
C.Lombard for review
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Trinity Community Ministries
Byrdine F Lewis School of Nursing and Health Professions
Derek Duncan
Phone: 404-577-6651 X 243
21 Bell Street NE
Atlanta GA 30303
Agency Email: derekd@tcmatlanta.org
Expiration Date: 2021-08-31
Sent to Facility: 2021-07-21
Sent to Provost: 2018-09-24
Sent to Legal:
Completed: 2018-09-27
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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con
con conLN
Phone: 88966782476
https://www.house-cleaner-nyc.com/ Maputo
Maputo Mozambique 114523
Agency Email: hayden@house-cleaner-nyc.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: con con
Document 1:
Document 2:
Document 3:
Comment: Standard cleaning
HI.
In modern the companies work competent specialists.
Cleaning international company Cleaning service appeared total-only 6 years ago, this notwithstanding swift dynamic mprovement still does not cease surprise all ours rivalsandnew customers , however practically none special secret in the swift improvement of our firms notavailable.
Despite on the impressive practical gained experience, service staff systematically enhances his qualification on diverse training and on courses. Listed assist perfect measure master new equipment and equipment .
Employees of our company are ready to provide professional cleaning services such as:
General cleaning apartments, workshops , stores and offices
Daily maintenance of cleanliness in the room
Deep cleansing and decorative treatment of floors slip prevention
Putting order after repair and construction work
Chemical cleaning of all types of carpet
Cleaning exterior glass surfaces, cleaning building facades
Seasonal cleaning outside the building
Disposal of trash and snow under license.
And likewise you can order:
Mattress cleaning, Postconstruction cleaning, Cleaning and tidying up., Corporate cleaning, Professional house cleaning, Best house cleaning, Marble care]
We commit cleaning only special cleaning supply. Fast increase in the number of cleaning firms in Prospect Hights proves that and in the area represented learned to appreciate own free time.
Serving around Williamsburg AND ON ALL STREETS, SUCH AS: High Bridge, Throgs Neck, City Line , Waterside Plaza, Grasmere .
And so exclusively you can here be sure, come in specified site and make an order services .
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Marvelous Light Consulting, LLC
Byrdine F Lewis School of Nursing and Health Professions
Dewanda Jackson
Phone: 404-286-0054
4319 Covington Highway Suite 110
Decatur GA 30036
Agency Email: djackson@mlccounselingservices.com
Expiration Date: 2024-10-31
Sent to Facility: 2018-09-19
Sent to Provost: 2018-10-15
Sent to Legal:
Completed: 2021-12-14
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Be Well Nutrition
Department of Nutrition
Val Evanoff
Phone: 404-441-5046
1724 Healey Wallk
Smyrna Ga 30082
Agency Email: info@bwnutrition.com
Expiration Date:
Sent to Facility: 2018-09-19
Sent to Provost: 2018-10-02
Sent to Legal:
Completed:
Requester Name: jessica todd
Document 1: view
Document 2:
Document 3:
Comment: Clinical
renewal
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Ronnie Blount MD
Byrdine F Lewis School of Nursing and Health Professions
Ronnie Blount
Phone: 478-787-6910
125A 1st Street
Macon GA 31201
Agency Email: rblount57@msn.com
Expiration Date: 2021-09-30
Sent to Facility: 2021-10-27
Sent to Provost: 2018-10-02
Sent to Legal:
Completed: 2018-10-26
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Greater Atlanta Speech and Language Clinics Inc.
Department of Occupational Therapy
Michelle Needle
Phone: 770-977-9457
1515 Johnson Ferry Rd
Marietta Ga 30062
Agency Email: michelle_needle@yahoo.com
Expiration Date: 2024-09-30
Sent to Facility: 2018-09-19
Sent to Provost: 2018-10-19
Sent to Legal:
Completed: 2021-07-06
Requester Name: Shana Finks
Document 1: Greater Atlanta Speech and Language Clinics Inc.
Document 2:
Document 3:
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adbcrlx
Department of Nutrition
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Phone: 8031286846
EUuPcJBHKgqfM ZgdAGoyHRDxsjkNxVMA
ACTunZrALGgIclDX QJOkyGwu 24469
Agency Email: bgaycr@nfzgmt.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: adbcrlx adbcrlx
Document 1: view
Document 2: view
Document 3: view
Comment: ePTjgP ewzkrzsnzwhd,
[url=http://xizwiohtnufa.com/]xizwiohtnufa[/url],
[link=http://ablgtazdwtxj.com/]ablgtazdwtxj[/link], http://asaagqulumbk.com/
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Regency Hospital Company South Atlanta, LLC
Byrdine F Lewis College of Nursing and Health Professions
Stephanie Dean
Phone: 404-466-4600
1170 Cleveland Ave, 4th Floor
East Point GA 30334
Agency Email: unknown
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Kelli Nowviskie
Document 1: Regency Hosp Co So Atlanta Final
Document 2:
Document 3:
Comment: auto renews annually
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Walter Reed National Military Medical Center
Department of Physical Therapy
Agnes Moyeno
Phone: 301-400-2219
8955 Wood Road WRNMMC Graduate Medical Education
Bethesda MD 20889
Agency Email: agnes.m.moyeno.civ@mail.mil
Expiration Date: 2025-09-14
Sent to Facility: 2018-10-26
Sent to Provost: 2018-12-07
Sent to Legal:
Completed: 2022-08-15
Requester Name: Carla Huggins
Document 1: View
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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Hands on Healing PC
Department of Occupational Therapy
Michelle Deutscher
Phone: 770-460 0165
290 Bradywine Blvd
Fayetteville Ga 30214
Agency Email: mdeutscher@comcast.net
Expiration Date: 2026-07-31
Sent to Facility: 2018-10-10
Sent to Provost: 2018-10-15
Sent to Legal:
Completed: 2023-08-24
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
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The Cozy Nest
Department of Occupational Therapy
Lindsey Gessner
Phone: 406 587 2755
2020 Gilkerson Dr.
Bozeman Montanta 59715
Agency Email: thecozynest@msn.com
Expiration Date: 2021-09-30
Sent to Facility: 2022-07-19
Sent to Provost: 2018-11-21
Sent to Legal:
Completed: 2018-11-30
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
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Physio
Department of Occupational Therapy
Robert McClellan
Phone: 4043552913
3200 Downwood Circle NW Suite 350
Atlanta GA 30327
Agency Email: rmcclellan@myphysio.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-07
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
Comment: Thanks Wanda!
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The Christ Hospital Health Network
Department of Occupational Therapy
Gerron McKnight
Phone: 513-585-3971
2139 Auburn Ave
Cincinnati OH 45219
Agency Email: gerron.mcknight@thechristhospital.com
Expiration Date: Auto-renew
Sent to Facility: 2018-12-19
Sent to Provost: 2019-01-07
Sent to Legal:
Completed: 2019-01-17
Requester Name: Carolyn Podolski
Document 1:
Document 2: Christ Hosp Auto Renews
Document 3:
Comment: 12/17/18 C.Lombard sent redlined version, sent to
facility.
12/19/18 Legals have agreed on language, at facility for
signatures.
1/7/19 to provost for signature
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Shady Grove Fertility
Byrdine F Lewis School of Nursing and Health Professions
Mark Perloe
Phone: 404-843-2229
5445 Meridian Mark Road
Atlanta GA 30342
Agency Email: mark.perloe@integramed.com
Expiration Date:
Sent to Facility: 2018-12-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 12/19/18 Dr. Perloe responded they are in a stressful
period of transition and ask that we contact them in 6
months.
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Intermed Hospital
School of Nursing
Amarmend Bayaraa
Phone: 976-8902 2202
Chinggis Avenue 41 Khan-Uul District
, Ulidver Ulaanbaatar 17040
Agency Email: amarmend.b@intermed.mn
Expiration Date: 2021-09-31
Sent to Facility: 2018-10-10
Sent to Provost: 2018-10-15
Sent to Legal:
Completed: 2018-10-26
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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InpharmD
Health Informatics
Ashish Advani
Phone: 404.606.1073
3423 Piedmont Rd
Atlanta GA 30305
Agency Email: ashish@inpharmd.com
Expiration Date:
Sent to Facility: 2018-10-11
Sent to Provost: 2018-10-15
Sent to Legal:
Completed:
Requester Name: Cedric Truss
Document 1: view
Document 2:
Document 3:
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Sensational Kids, LLC
Department of Occupational Therapy
Shellie Szmyd
Phone: 307 634 2273
918 W Brundage Lane
Sheridan Wyoming 82801
Agency Email: saszmyd@aol.com
Expiration Date: 2021-09-30
Sent to Facility: 2018-10-19
Sent to Provost: 2018-10-24
Sent to Legal:
Completed: 2018-10-30
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: Thanks!
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Massachusetts General Hospital
Department of Respiratory Therapy
Karyn Besegai
Phone: 617-724-3019
55 Fruit Street 3/320 B
Boston MA 02114
Agency Email: kbesegai@partners.org
Expiration Date: 2020-12-31
Sent to Facility: 2019-03-04
Sent to Provost: 2018-10-19
Sent to Legal:
Completed: 2019-03-12
Requester Name: Ralph Zimmerman
Document 1:
Document 2: Final Expires Dec 2020
Document 3:
Comment: 11/20/18 Legal made changes. To facility for review.
Email from Contact: Please find attached a copy our
standardized Partner’s contract between MGH and Georgia
State University or your review and signature. Please
note that, due to the volume of contracts we manage and
the need for consistency across Partners entities, we are
no longer able to consider edits or revisions to the
agreement (no exceptions will be made). Once endorsed,
please return a signed hardcopy of the agreement to the
address listed below. If you wish to retain a fully-
executed original, please mail 2 signed copies and
include a self-addressed envelope. If you opt to provide
insurance coverage rather than agree to the indemnity
clause, please include evidence of the professional
liability insurance naming the MGH as a certificate
holder and the general liability insurance naming the MGH
as an additional insured with the signed copy of the
agreement. The insurance documents are subject to review
by our risk assessment
team; we ask that you please adhere to the contract
language precisely in order to avoid significant delays.
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Urban Health and Wellness
Byrdine F Lewis School of Nursing and Health Professions
Susan Whatley
Phone: 404-618-6983
859 Metropolitan Parkway, SW
Atlanta GA 30310
Agency Email: susanw.uhw@gmail.com
Expiration Date: 2021-09-30
Sent to Facility: 2021-10-29
Sent to Provost: 2018-10-29
Sent to Legal:
Completed: 2018-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Mission Health System
Byrdine F Lewis School of Nursing and Health Professions
Brooke Wetzel
Phone: 828 213 3950
1 Hospital Drive Suite 6300
Asheville North Carolina 28801
Agency Email: brooke.wetzel@msj.org
Expiration Date: 2021-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires May 2021
Document 2:
Document 3:
Comment: Please copy Masiki Williamson on communication at ptclinicaleducation@gsu.edu. Thank you.
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Healthstat
Byrdine F Lewis School of Nursing and Health Professions
Jill Patton
Phone: 704-936-5546
4651 Charlotte Park Drive Suite 300
Charlotte NC 28217
Agency Email: jill.patton@healthstatinc.com
Expiration Date: 2021-10-09
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2018-10-11
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Womens Specialists of Fayette (The)
Byrdine F Lewis School of Nursing and Health Professions
Rita Hooper
Phone: 770-632-9900
1267 Hwy 54 West Suite 3200
Fayetteville GA 30214
Agency Email: rhooper@wsfayette.com
Expiration Date: 2021-10-31
Sent to Facility: 2021-10-31
Sent to Provost: 2018-11-13
Sent to Legal:
Completed: 2018-11-30
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Jersey City Medical Center, an affiliate of RWJBarnabas Health, Inc.
Department of Occupational Therapy
Jenna Camacho
Phone: 201.984-1300
414 Grand Street
Jersey City NJ 07302
Agency Email: jenna.camacho@rwjbh.org
Expiration Date: 2021-05-31
Sent to Facility: 2019-03-29
Sent to Provost: 2018-12-06
Sent to Legal:
Completed: 2019-05-01
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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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:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical agreement
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Novant Health, Inc
Department of Occupational Therapy
Kimberly Schnitzler
Phone: 336-277-6703
200 Hawthorne Lane suite 203
Charlotte NC 28204
Agency Email: kschnitzler@novanthealth.org
Expiration Date: Auto Renews
Sent to Facility: 2018-10-11
Sent to Provost:
Sent to Legal:
Completed: 2020-02-20
Requester Name: Carolyn Podolski
Document 1: Auto Renews ...213164900pdf
Document 2:
Document 3:
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Skills on the Hill, LLC
Department of Occupational Therapy
Kristen McLaughlin
Phone: Phone: 202-544-5439
405 8th St. NE
Washington DC 20002
Agency Email: Kristen.mclaughlin@skillsonthehill.com
Expiration Date: 2027-02-28
Sent to Facility: 2018-10-31
Sent to Provost: 2024-03-18
Sent to Legal:
Completed: 2024-03-25
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
Comment: Kelli, Please copy me when you send out the MOU. Thanks
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North Atlanta Medical & Digestive Care
School of Nursing
Jeff Ye
Phone: 770-346-0900
4020 Old Milton Parkway
Alpharetta GA 30005
Agency Email: dryemailbox@gmail.com
Expiration Date: 2024-10-31
Sent to Facility: 2018-10-25
Sent to Provost: 2018-10-31
Sent to Legal:
Completed: 2021-11-01
Requester Name: Lisa Williams
Document 1: view
Document 2: North Atlanta Medical & Digestive Care
Document 3:
Comment:
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Cullman Regional Medical Center
Department of Occupational Therapy
Leeann Plank
Phone: 256 737 2271
1912 AL157
Cullman AL 35058
Agency Email: leeann.plank@cullmanregional.com
Expiration Date:
Sent to Facility: 2024-02-15
Sent to Provost: 2024-04-09
Sent to Legal: 2024-02-23
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Kelli, Cullman Regional uses their own Affiliation
Agreement. I attached it to this request. I am also
sending it in an email today 11/1/18 just in case the
upload didnt work. Please send it on to legal. Thanks so
much.
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JAG-ONE Physical Therapy
Department of Occupational Therapy
Erin Quinn
Phone: 973-669-0078
900 Route 9
North Woodbridge NJ 07095
Agency Email: equinn@jagpt.com
Expiration Date: 2021-11-30
Sent to Facility:
Sent to Provost: 2024-02-28
Sent to Legal:
Completed: 2024-03-06
Requester Name: Karen McWaters
Document 1: JAG ONE Final
Document 2:
Document 3:
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Womens Specialists of North Georgia
Byrdine F Lewis School of Nursing and Health Professions
Raquel Montanez
Phone: 770-676-5878
2169 Lawrenceville Highway
Lawrenceville GA 30044
Agency Email: raquel@doctoresteves.com
Expiration Date: 2024-06-30
Sent to Facility: 2021-06-23
Sent to Provost:
Sent to Legal:
Completed: 2021-08-20
Requester Name: Lisa Williams
Document 1: Womens Specialists of North Georgia
Document 2:
Document 3:
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Penguin Pediatrics PLLC
School of Nursing
Heysel Ortega
Phone: 571-223-5140
44095 Pipeline Plaza Suite 410
Ashburn VA 20147
Agency Email: penguinpediatrics@gmail.com
Expiration Date: 2021-11-30
Sent to Facility: 2018-11-21
Sent to Provost: 2018-11-27
Sent to Legal:
Completed: 2018-12-17
Requester Name: Lisa Williams
Document 1: Penguin FINAL
Document 2:
Document 3:
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Dzung Tran MD
Byrdine F Lewis School of Nursing and Health Professions
Michelle Bromelia
Phone: 702-876-0186 x209
6960 Cimarron Road Suite 100
Las Vegas NV 89113
Agency Email: michelle@drtranmdlasvegas.com
Expiration Date: 2021-11-30
Sent to Facility: 2018-11-21
Sent to Provost:
Sent to Legal:
Completed: 2018-12-18
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Middle Georgia Medical Associates
Byrdine F Lewis School of Nursing and Health Professions
Sharon Culpepper
Phone: 478-923-6633
623 S. Houston Lake Road Suite 200
Warner Robins GA 31088
Agency Email: sharon.mgma@yahoo.com
Expiration Date: 2021-11-30
Sent to Facility: 2021-10-27
Sent to Provost: 2018-12-19
Sent to Legal:
Completed: 2019-02-21
Requester Name: Lisa Williams
Document 1: Final Expires November 2021
Document 2:
Document 3:
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Jacobs Ladder Neurodevelopmental School and Therapy Center
Department of Occupational Therapy
Amber Duckworth
Phone: (770) 998-1017
407 Hardscrabble Rd
Roswell Ga 30075
Agency Email: frontoffice@jacobsladderschool.net
Expiration Date: 2021-11-30
Sent to Facility: 2018-11-21
Sent to Provost: 2018-11-26
Sent to Legal:
Completed: 2018-11-30
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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Atlanta Speech School
Department of Occupational Therapy
Meagan Gordon
Phone: (404) 233‑5332
3160 Northside Parkway NW
Atlanta GA 30327
Agency Email: mgordon@atlantaspeechschool.org
Expiration Date: 2025-07-31
Sent to Facility: 2018-11-21
Sent to Provost: 2018-12-07
Sent to Legal:
Completed: 2022-08-08
Requester Name: Jennifer Nelson
Document 1: Atlanta Speech School FINAL
Document 2:
Document 3:
Comment: ABell@atlantaspeechschool.org is the new contact -8-10-22If
Meagan Gordon is no longer there, please try:
Roeline du Plessis
RDuPlessis@atlantaspeechschool.org
Thank you!
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Fannin Regional Hospital
Byrdine F Lewis School of Nursing and Health Professions
Lori Barker
Phone: 706-258-4640
2855 Old Hwy 5
Blue Ridge GA 30513
Agency Email: Lori_Barker@QuorumHealth.com
Expiration Date: 2019-12-31
Sent to Facility: 2020-08-10
Sent to Provost: 2020-07-06
Sent to Legal: 2020-06-26
Completed:
Requester Name: Lisa Williams
Document 1: Expires December 31 2019
Document 2:
Document 3:
Comment: 3/4/2020 asked facility to renew, they use their own
template.
6/26/20 Facility sent amendment to extend current/recently
expired agreement. to C. Lombard for review.
8/10/20 to facility for final signature
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Memorial Hospital and Manor
Byrdine F Lewis School of Nursing and Health Professions
Karen Williams
Phone: 229-243-6100 x423
1500 East Shotwell Street
Bainbridge GA 39819
Agency Email: HR-spec2@mh-m.org
Expiration Date: 2026-02-28
Sent to Facility: 2020-03-04
Sent to Provost: 2020-03-06
Sent to Legal:
Completed: 2023-02-28
Requester Name: Lisa Williams
Document 1: exp feb 2023 ...6133531pdf
Document 2:
Document 3:
Comment: 3/8/20 Karen Williams forwarded to Deborah Brown
DeborahB@mh-m.org
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Friends of Disabled Adults & Children
Health Informatics
David Carroll
Phone: 770-491-9014 x124
4900 Lewis Road
Stone Mountain GA 30083
Agency Email: davidcarroll@fodac.org
Expiration Date: 2024-08-31
Sent to Facility: 2018-11-21
Sent to Provost: 2018-11-27
Sent to Legal:
Completed: 2021-09-15
Requester Name: Cedric Truss
Document 1:
Document 2:
Document 3:
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OB-GYN Associates
Byrdine F Lewis School of Nursing and Health Professions
Robin Franklin
Phone: 770-422-8700
699 Church Street Suite 300
Marietta GA 30060
Agency Email: RHF515@gmail.com
Expiration Date: 2021-11-30
Sent to Facility: 2018-11-30
Sent to Provost: 2018-12-07
Sent to Legal:
Completed: 2018-12-14
Requester Name: Lisa Williams
Document 1: OBGYN Assoc Final
Document 2:
Document 3:
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Pediatric Infectious Disease Associates, P.C.
Byrdine F Lewis School of Nursing and Health Professions
Kristy Flockert
Phone: 404-252-4611
6100 Lake Forrest Drive
Atlanta GA 30338
Agency Email: KFlockert@sspediatrics.com
Expiration Date:
Sent to Facility: 2018-12-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 1/24/19 On hold per Lisa Williams
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Rimidi
Health Informatics
Lucienne Ide
Phone: 404-317-4400
400 Trabert Avenue
Atlanta Georgia 30309
Agency Email: lucie@rimidi.com
Expiration Date: 2022-12-31
Sent to Facility: 2018-12-13
Sent to Provost: 2018-12-19
Sent to Legal:
Completed: 2018-12-18
Requester Name: Dr. Cedric Truss
Document 1: Final Expires Dec 2022
Document 2:
Document 3:
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Leaf and Loaf LLC
Department of Nutrition
Sue Snape
Phone: 770-309-4627
2433 Kingsley Dr. NE
Marietta GA 30062
Agency Email: snapesue@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2018-12-19
Sent to Provost: 2019-01-23
Sent to Legal:
Completed: 2019-02-21
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: non-clinical agreement
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Fulton County Department of Senior Services
Department of Nutrition
Joe Englebird
Phone: 678-427-4356
137 Peachtree Street ste 2
atlanta ga 30303
Agency Email: joe.engelbird@fultoncountyga.gov
Expiration Date:
Sent to Facility: 2018-12-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical agreement
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College of Coastal Georgia
Byrdine F Lewis School of Nursing and Health Professions
Lydia Watkins
Phone: 912-279-5906
1 College Drive Health Sciences 210
Brunswick GA 31520
Agency Email: lwatkins@ccga.edu
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:
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Prime Healthcare Foundation - Southern Regional, LLC., dba Southern Regional Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Sharon Lawson-Mathis
Phone: 770-991-8392
11 Upper Riverdale Road, SW
Riverdale GA 30274
Agency Email: slawson-mathis@primehealthcare.com
Expiration Date: auto renews
Sent to Facility: 2019-08-16
Sent to Provost: 2019-09-05
Sent to Legal: 2019-07-02
Completed: 2019-09-03
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
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Chesapeake Occupational Therapy Associates, LLC
Department of Occupational Therapy
Debra Taylor
Phone: 410-280-8774
1410 Forest Drive #29
Annapolis Md 21403-1482
Agency Email: chesapeakeOTDRT@gmail.com
Expiration Date: 2023-01-31
Sent to Facility: 2022-09-21
Sent to Provost: 2020-04-06
Sent to Legal:
Completed: 2020-04-07
Requester Name: Jennifer Nelson
Document 1: ExpJan2023 ChesapeakOT - signed
Document 2:
Document 3:
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Encore Rehabilitation Inc.
Department of Occupational Therapy
John Henderson
Phone: 256 318 3601
251 Johnston St SE Suite 200
Decatur AL 35601
Agency Email: jchenderson@encorerehab.com
Expiration Date: 2022-01-31
Sent to Facility: 2018-12-19
Sent to Provost: 2019-02-12
Sent to Legal:
Completed: 2019-02-14
Requester Name: Shana Finks
Document 1: View
Document 2:
Document 3:
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Grace Village Medical Clinic
Byrdine F Lewis School of Nursing and Health Professions
Michael Sorrells
Phone: 770-979-7000
4002 E. Ponce de Leon Avenue
Clarkston GA 30021
Agency Email: Sorr1135@bellsouth.net
Expiration Date: 2025-01-31
Sent to Facility: 2019-01-11
Sent to Provost: 2019-01-17
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Kindred Rehab Services, Inc., d/b/a RehabCare and Kindred Hospital Rehabilitation Services
Department of Occupational Therapy
Annie Roden
Phone: 314-659-2131
7733 Forsyth Blvd Suite 1700
St. Louis MO 63105
Agency Email: Annie.Roden@rehabcare.com
Expiration Date:
Sent to Facility: 2019-03-21
Sent to Provost: 2018-12-19
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: 3/20/19 C. Lombard reviewed, has changes/redlines.
6/3/19 C. Podolski to reach out to them checking on status of
their review of our redlines as we have not heard from facility.
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Greater Atlanta Womens Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Vincent Williams
Phone: 404-589-2670
550 Peachtree Street NE Suite 1470
Atlanta GA 30308
Agency Email: vincent.williams@gawhc.com
Expiration Date: 2022-01-31
Sent to Facility: 2022-01-19
Sent to Provost: 2019-01-30
Sent to Legal:
Completed: 2019-02-12
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Lotus Family Wellness Clinic
Byrdine F Lewis School of Nursing and Health Professions
Qiana Johnson
Phone: 470-575-6588
1240 Highway 138
Riverdale GA 30296
Agency Email: info@lotusfamilywellnessclinic.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-06-15
Sent to Provost: 2019-08-09
Sent to Legal:
Completed: 2019-08-19
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
Comment: Facility charges a fee. Marking inactive. -Kelli
7/31/19 - Site is no longer charging a fee Please re-send
contract.
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Southern Crescent Family Practice
Byrdine F Lewis School of Nursing and Health Professions
Michelle Tyson
Phone: 678-705-0100
455 Forest Parkway
Forest Park GA 30297
Agency Email: SCFPLLCTYSON@COMCAST.NET
Expiration Date: 2022-02-28
Sent to Facility: 2022-02-02
Sent to Provost: 2019-02-22
Sent to Legal:
Completed: 2019-03-01
Requester Name: Lisa Williams
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
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Fairfax County School Board
Department of Occupational Therapy
Judy DuPrey
Phone: 571.423.4864
8270 Willow Oaks Corporate, 2120
Fairfax Va 22031
Agency Email: jaduprey@fcps.edu
Expiration Date: auto renews
Sent to Facility: 2019-03-25
Sent to Provost: 2019-05-19
Sent to Legal:
Completed: 2019-05-23
Requester Name: Carolyn Podolski
Document 1: Final May2019 Auto Renews
Document 2:
Document 3:
Comment: Fairfax CPS wants original final document - sent original
to Kisha via inter office mail 5/19/19
Auto Renews
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Patientory, Inc.
Health Informatics
Chrissa McFarlane
Phone: (678) 951-9007
3423 Piedmont Road NE
Atlanta GA 30305
Agency Email: chrissa@patientory.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-18
Sent to Provost:
Sent to Legal:
Completed: 2019-02-26
Requester Name: Cedric Truss Lowell Sanders
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment: Hello,
When sending the MOU to the organization please cc Mandar
Joshi, Chief Technology Officer: mandar@patientory.com
on
the email. Additionally copy Cedric Truss and Lowell
Sanders on the email as well: ctruss@gsu.edu and
lsanders31@gsu.edu
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Cleveland Clinic Foundation
Department of Nutrition
Kerilyn Gillombardo
Phone: 216-444-6143
9500 Euclid Ave NA31
Cleveland OH 44195
Agency Email: gillomk@ccf.org
Expiration Date: 2019-12-31
Sent to Facility: 2019-10-31
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: jessica todd
Document 1: Final Exp Dec 2019
Document 2:
Document 3:
Comment: 10/31/19 emailed request to renew to facility
11/14/19 Completed Renew Request form on their site
12/4/19 Clinic does not wish to continue the relationship
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Buford Norcross Primary Care
Byrdine F Lewis School of Nursing and Health Professions
Christine Li-Qun Bao
Phone: 770-246-6100
777 West Peachtreet Street
Norcross GA 30071
Agency Email: bnpc777@yahoo.com
Expiration Date: 2025-10-31
Sent to Facility: 2019-10-29
Sent to Provost: 2019-11-06
Sent to Legal:
Completed: 2023-11-10
Requester Name: Lisa Williams
Document 1: Exp Oct 2022 140416
Document 2:
Document 3:
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Veterans Empowerment Organization of Georgia Inc.
Department of Occupational Therapy
Laurel McClendon
Phone: 4048898710 ext 26
373 West Lake Ave NW
Atlanta Ga 30318
Agency Email: laurel.mcclendon@veohero.org
Expiration Date: 2022-01-31
Sent to Facility: 2021-03-12
Sent to Provost: 2019-01-24
Sent to Legal:
Completed: 2019-07-08
Requester Name: Carolyn Podolski
Document 1: Final Expires December 2023
Document 2:
Document 3:
Comment: Kelli,
Please use the same contract we used for Gigis Playhouse,
both facilities are non-medical in nature and this
contract fits better. It has been approved for use by our
Legal department. I am attaching a copy of Gigis MOU,
just change out the name. Please make this for the whole
GSU university.
For the signature line please put in the name of the
Executive Director: Frantz Fortune.
Thanks so much!
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Regenerative Orthopedics and Spine Institute, PC
Byrdine F Lewis School of Nursing and Health Professions
Robin Swords
Phone: 770-892-0300
135 North Park Place Suite 101
Stockbridge GA 30281
Agency Email: rswords@rosi.us
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-17
Sent to Provost: 2019-01-28
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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Little Goose Therapy DBA Advance Therapy
Department of Occupational Therapy
Bri Martin
Phone: 307 683 0123
727 E Brundage Ln
Sheridan Wy 82801
Agency Email: bri@advancesheridan.com
Expiration Date: 2027-02-28
Sent to Facility: 2022-07-19
Sent to Provost: 2024-03-18
Sent to Legal:
Completed: 2024-03-25
Requester Name: Karen McWaters
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: Ownership has stayed the same, but we are now Little Goose
Therapy DBA Advance Therapy. formerly called Teton Therapy
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Cobb Medical Clinic
Byrdine F Lewis School of Nursing and Health Professions
Chandresh Shah
Phone: 770-941-0010
2615 East-West Connector Suite 106
Austell GA 30106
Agency Email: care@cobbmedicalclinic.com
Expiration Date: 2025-01-31
Sent to Facility: 2019-01-17
Sent to Provost: 2019-01-22
Sent to Legal:
Completed: 2022-04-04
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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United Behavioral Health Solutions, Inc.
BFLCNHP
Wesley Sumpter
Phone: 404-445-5758
3104 Mercer University Drive Suite 100
Atlanta GA 30341
Agency Email: wsumpter@ubhsinc.com
Expiration Date: 2022-01-31
Sent to Facility: 2022-01-27
Sent to Provost: 2019-01-24
Sent to Legal:
Completed: 2019-01-30
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Able Rehab
Department of Occupational Therapy
Colleen Goodwin
Phone: (770) 783-9797
2000 Mirror Lake Blvd Suite T
Villa Rica Ga 30180
Agency Email: ablerehab1@gmail.com
Expiration Date: 2022-01-31
Sent to Facility: 2024-02-07
Sent to Provost: 2019-01-30
Sent to Legal:
Completed: 2019-01-30
Requester Name: Shana Finks
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Reproductive Health Medicine and Gynecology
Byrdine F Lewis School of Nursing and Health Professions
Nicholas Kongoasa
Phone: 770-450-8677
3965 Holcomb Bridge Road Suite 100
Norcross GA 30092
Agency Email: info@rhmgyn.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-01-25
Sent to Provost: 2019-02-12
Sent to Legal:
Completed: 2019-02-14
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Alpha Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Tkeyah Dooley
Phone: 678-619-1974
480 N. Main Street suite 202
Alpharetta GA 30009
Agency Email: info@alphafm.net
Expiration Date: 2023-03-31
Sent to Facility: 2019-01-28
Sent to Provost: 2019-01-30
Sent to Legal:
Completed: 2022-04-04
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Team Rehab
Department of Physical Therapy
Robin Wilenius
Phone: (248) 419-3388
32000 Northwestern Hwy Suite 180
Farmington Hills MI 48334
Agency Email: robin.wilenius@team-rehab.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: ExpJan2022 TeamRehab forProvost signed
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Georgia Center for Female Health
Byrdine F Lewis School of Nursing and Health Professions
Nannette Camacho
Phone: 404-243-7777
3660 Flat Shoals Road Suite 180
Decatur GA 30034
Agency Email: NannetteC@gafemalehealthandmedspa.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-02-07
Sent to Provost: 2019-07-08
Sent to Legal:
Completed: 2019-07-08
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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A Q Medical Associates, LLC
Byrdine F Lewis School of Nursing and Health Professions
Irfan Qazi
Phone: 470-589-1065
4485 Tench Road Suite 740
Suwanee GA 30024
Agency Email: dranjumqazi@hotmail.com
Expiration Date: 2022-01-31
Sent to Facility: 2019-02-07
Sent to Provost: 2019-02-19
Sent to Legal:
Completed: 2019-03-01
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Northlake OB/GYN
School of Nursing
Juliette Downie
Phone: 770-939-5102
3957 Holcomb Bridge Road Suite 100
Norcross GA 30092
Agency Email: practiceadmin@northlakegyn.com
Expiration Date: 2022-01-31
Sent to Facility: 2022-01-19
Sent to Provost: 2019-02-08
Sent to Legal:
Completed: 2019-02-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Building Blocks Pediatrics, LLC
Department of Occupational Therapy
Erin Patrick
Phone: 770-321-6705
1230 Johnson Ferry Place Suite G 10
Marietta Ga 30068
Agency Email: erinp@buildingblockspediatric.com
Expiration Date: 2022-01-31
Sent to Facility: 2022-07-13
Sent to Provost: 2019-02-14
Sent to Legal:
Completed: 2019-02-19
Requester Name: Shana Finks
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Quality Care for Children
Department of Nutrition
Monica Griffin
Phone: 4044794190
3 Corporate Blvd. NE, 230
Atlanta GA 30329
Agency Email: monica.griffin@qccga.org
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non-clinical request
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Womens Health Professionals
Byrdine F Lewis School of Nursing and Health Professions
Lynette Talley
Phone: 229-883-4555
414 5th Avenue
Albany GA 31701-1976
Agency Email: info@womenshealthalbany.com
Expiration Date: 2022-01-31
Sent to Facility: 2022-01-19
Sent to Provost: 2019-02-12
Sent to Legal:
Completed: 2019-02-14
Requester Name: Lisa Williams
Document 1: Final Expires January 2022
Document 2:
Document 3:
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Southern Therapy Services, Inc.
Department of Occupational Therapy
Sherri Evans
Phone: 678-390-6161
120 East Center St
Carrollton Ga 30117
Agency Email: sevans@southerntherapy.org
Expiration Date:
Sent to Facility: 2019-02-13
Sent to Provost: 2019-02-20
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1: Final Expires January 2022
Document 2:
Document 3:
Comment: Thanks Kelli,
This is for OT and PT (they are a contract company and
only
has these services-no nursing or respiratory, etc.)There
was an old PT contract but it is expired.
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Elkhorn Valley Rehabilitation Hospital
Department of Occupational Therapy
Danielle Nielsen
Phone: 307-265-0005
5715 E. 2nd Street
Caspar Wyoming 82609
Agency Email: daniellenielsen@ernesthealth.com
Expiration Date:
Sent to Facility: 2019-02-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Kelli,
Thanks for all of the work you do on these.
This one is for May, so we have some time.
Thanks!
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Perfectly Portioned Nutrition LLC
Department of Nutrition
Jessica Todd
Phone: 209-209-730-3429
860 Johnson Ferry Rd #215
Atlanta Georgia 30342
Agency Email: jessica@perfectlyportionednutrition.com
Expiration Date: 2025-02-28
Sent to Facility: 2019-02-22
Sent to Provost: 2019-02-28
Sent to Legal:
Completed: 2022-01-20
Requester Name: jessica todd
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: Non-clinical agreement
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Nutrition Atlanta
Department of Nutrition
Jennifer Hnat
Phone: 404.353.3482
1801 Peachtree Road NE 250
atlanta ga 30309
Agency Email: jennifer@atlantanutrition.com
Expiration Date: 2022-02-28
Sent to Facility: 2019-02-22
Sent to Provost: 2019-04-08
Sent to Legal:
Completed: 2019-04-17
Requester Name: Jessica Todd
Document 1: Final Expires Feb 2022
Document 2:
Document 3:
Comment: Nonclinical
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First Step Physical Therapy
Department of Physical Therapy
Josh Davis
Phone: 770-716-8885
500 W. Lanier Avenue, Suite 303
Fayetteville GA 30214
Agency Email: Dr.Davis@firststeppt.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-21
Sent to Legal:
Completed: 2022-05-03
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Locations include: Fayetteville, Roswell and Marietta
Copy ptclinicaleducation@gsu.edu
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Cobb Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
DeeDee Varner
Phone: 770-425-5331
3405 Dallas Highway
Marietta GA 30064
Agency Email: dvarner@cobbpeds.com
Expiration Date: 2022-03-31
Sent to Facility: 2023-03-08
Sent to Provost: 2019-03-14
Sent to Legal:
Completed: 2019-03-29
Requester Name: Lisa Williams
Document 1: Final Expires March 2022
Document 2:
Document 3:
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Family Care Clinic PC
Byrdine F Lewis School of Nursing and Health Professions
Renzo Fornasini
Phone: 770-622-3948
3985 Steve Reynolds Boulevard
Norcross GA 30093
Agency Email: Fornasinipediatrics@gmail.com
Expiration Date: 2025-03-31
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-26
Sent to Legal:
Completed: 2022-04-13
Requester Name: Lisa Williams
Document 1: Final Expires March 2022
Document 2:
Document 3:
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R. Jason Kent Physical Therapy
Department of Physical Therapy
Emily Kent
Phone: 470.885.0880
4861 Bill Gardner Pkwy
Locust Grove GA 30248
Agency Email: emilybkent@yahoo.com
Expiration Date: 2022-03-31
Sent to Facility: 2022-02-22
Sent to Provost: 2019-03-18
Sent to Legal:
Completed: 2019-03-21
Requester Name: Carla Huggins
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: Contract to cover: Locust Grove,Macon, and Warner Robins
Clinics
Copy ptclinicaleducation@gsu.edu
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Bruce J. Beeber MD
Byrdine F Lewis School of Nursing and Health Professions
Amy Moon
Phone: 770-922-1400
1009 Milstead Avenue Suite 110
Conyers GA 30012
Agency Email: frontoffice@beebermd.com
Expiration Date: 2022-03-31
Sent to Facility: 2019-03-13
Sent to Provost: 2019-03-25
Sent to Legal:
Completed: 2019-03-29
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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PruittHealth Therapy Services
Byrdine F Lewis School of Nursing and Health Professions
Penny Wheeler
Phone: 770-507-3848
1050 Hospital Dr.
Stockbridge GA 30281
Agency Email: pestoker@pruitthealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Clinical Education Director for all of Pruitt Health
Facilities is Penny Wheeler pestoker@pruitthealth.com
704-439-6198
Copy ptclinicaleducation@gsu.edu
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Married to Health
Department of Nutrition
James Marin
Phone: (949)732-1707
4533 MacArthur Boulevard 5228
Newport Beach, CA 92660
Agency Email: James@marriedtohealth.com
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-16
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
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Stout Healthcare
Department of Physical Therapy
James Stout
Phone: (301) 275-4057
PO Box 871
Ooltewah TN 37363
Agency Email: jimmystout@gmail.com
Expiration Date: 2022-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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A New Beginning Health Services DBA Douglasville Childrens Therapy Services and Associates
Department of Physical Therapy
Nichole Edwards
Phone: 770-577-0399
2562 Fairburn Rd Suite D 20
Douglasville GA 30135
Agency Email: Nichole.edwards@dctsaa.com
Expiration Date: 2026-04-30
Sent to Facility: 2019-03-28
Sent to Provost: 2019-04-16
Sent to Legal:
Completed: 2023-09-22
Requester Name: Carla Huggins
Document 1: Final Expires March 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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The Asthma Allergy and Sinus Center
Byrdine F Lewis School of Nursing and Health Professions
Meredith Pippin
Phone: 770-534-0534
528 Broad Street SE Suite B
Gainesville GA 30501
Agency Email: mpippin@allergyasc.com
Expiration Date: 2022-03-31
Sent to Facility: 2023-03-08
Sent to Provost: 2019-04-09
Sent to Legal:
Completed: 2019-05-09
Requester Name: Lisa Williams
Document 1: Final Expires March 2022
Document 2:
Document 3:
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Graham Pediatrics of Woodstock
Byrdine F Lewis School of Nursing and Health Professions
Maylor Graham
Phone: 770-485-9670
105 Mirramont Lake Drive
Woodstock GA 30189
Agency Email: maylorgraham@grahampediatrics.com
Expiration Date: 2022-03-31
Sent to Facility: 2023-03-08
Sent to Provost: 2019-04-09
Sent to Legal:
Completed: 2019-04-17
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Peachtree Orthopedics
Department of Physical Therapy
Jeff Clement
Phone: 404-355-0743 x 1374
3200 Downwood Circle
Atlanta GA 30327
Agency Email: jclement@pocatlanta.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-06-05
Sent to Provost: 2019-06-08
Sent to Legal:
Completed: 2022-03-14
Requester Name: Carla Huggins
Document 1: Final exp may 2022 ...135933pdf
Document 2:
Document 3:
Comment: 7 PT locations:
Piedmont: 2001 Peachtree Rd, Suite 700, Atl 30309
West Paces: 3200 Downwood Circle, Suite 700, Atl 30327
Alpharetta: 11800 Amber Park Drive, Suite 200, Alpharetta
30009
College Park: 1901 Phoenix Blvd, Suite 120, College Park
30349
Duluth; 3870 Pleasant Hill Road, Suite 1, Duluth 30096
Northside: 5505 Peachtree Dunwoody Road, Suite 590, Atl
30342
Woodstock; 105 Smokehill Lane, Suite 120, Woodstock,
30188
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CORA Health Services, Inc.
Department of Physical Therapy
Robert Seahorn
Phone: 865-801-1366
1110 Shawnee Road
Lima Ohio 45805
Agency Email: info@corahealth.com
Expiration Date: 2025-05-23
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-16
Sent to Legal:
Completed: 2022-05-24
Requester Name: Carla Huggins
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: For any contract please include the language below:
Legal Entity Name: CORA Health Services, Inc.
Language must include:
- and CORA Health Services, Inc., a Delaware
corporation and/or any of its subsidiaries or affiliates
(collectively, “Facility”).
Insurance – Certificate of Insurance
The SCHOOL for its part agrees to maintain for its
faculty
and students a policy of professional liability
insurance,
with a single limit of no less than $1,000,000. A
Certificate of Insurance confirming this professional
liability coverage will be supplied to the FACILITY upon
execution of this Agreement and thereafter periodically
upon the FACILITY request.
CORA DESIGNATED SIGNER:
Brad Roush
Executive Vice President
General Counsel
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Agilitas USA Inc., D.B.A. Results Physiotherapy Centers
Department of Physical Therapy
Ashlee Butler
Phone: 615-405-2654
800 Crescent Centre Drive Suite 600
Franklin TN 37067
Agency Email: Ashlee.Butler@resultspt.com
Expiration Date: 2026-03-30
Sent to Facility: 2019-04-12
Sent to Provost: 2020-02-04
Sent to Legal:
Completed: 2023-02-11
Requester Name: Carla Huggins
Document 1: exp jan 2023 ...213165037pdf
Document 2:
Document 3:
Comment: Covered under Upstream Agreement.
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Mountainside Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Khawaja Raza Mahmood
Phone: 706-253-9898
12 Sammy McGhee Boulevard Suite 102
Jasper GA 30143
Agency Email: krazam@gmail.com
Expiration Date: 2025-04-30
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-30
Sent to Legal:
Completed: 2022-05-20
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
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Camp Blue Skies
Department of Nutrition
Kit Sluder
Phone: 704-301-6035
2820 Selwyn Ave Box 767
Charlotte NC 28209
Agency Email: kit@campblueskies.org
Expiration Date:
Sent to Facility: 2019-04-12
Sent to Provost: 2019-04-30
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement
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North Georgia Primary Care
Byrdine F Lewis College of Nursing and Health Professions
Bryan Hooker
Phone: 706-253-3842
14 Sammy McGhee Boulevard Suite 204
Jasper GA 30143
Agency Email: northgeorgiaprimary@gmail.com
Expiration Date: 2023-01-31
Sent to Facility: 2023-01-18
Sent to Provost: 2020-01-28
Sent to Legal:
Completed: 2020-02-11
Requester Name: Lisa Williams
Document 1: exp jan 2023 ...213165210pdf
Document 2:
Document 3:
Comment: 1/7/2020 - please send updated contract
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Northside Anesthesiology Consultants, LLC
Byrdine F Lewis School of Nursing and Health Professions
Mark Panfel
Phone: 770-645-5092
3155 North Point Parkway Building F-100
Alpharetta GA 30005
Agency Email: mpanfel@gaanes.com
Expiration Date:
Sent to Facility: 2019-10-31
Sent to Provost: 2019-10-21
Sent to Legal: 2019-10-08
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Updated clinic name from Envision Physicians Services
10/31/19 To facility for final signature
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Walmart Care Clinics, LLC
Byrdine F Lewis School of Nursing and Health Professions
Tracey Kniess
Phone: 412-500-3722
702 SW 8th Street
Bentonville AR 72716-0445
Agency Email: Tracey.Kniess@walmart.com
Expiration Date: auto renews
Sent to Facility: 2019-05-19
Sent to Provost:
Sent to Legal: 2019-04-12
Completed: 2019-05-20
Requester Name: Lisa Williams
Document 1: Final Auto Renews
Document 2:
Document 3:
Comment: 4/12/19 - template to Caroline Lombard for review.LYW
4/16/19 - to facility with changes from legal
5/19/19 - Provost signed, to facility for final signatures
Auto Renews annually
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test
Health Informatics
test test
Phone: test
test
test test test
Agency Email: vanessabrown@gsu.edu
Expiration Date:
Sent to Facility:
Sent to Provost: test
Sent to Legal: test2
Completed:
Requester Name: vanessa testing 4/29 Brown test
Document 1: my document
Document 2: my document2
Document 3: my document3
Comment: Lots of fun comments here.
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Sandy Springs Family Medicine And Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Beatris Dragonu
Phone: 770-696-2697
8640 Roswell Road
Sandy Springs GA 30350
Agency Email: bdragonu@fammed.org
Expiration Date: 2025-04-30
Sent to Facility: 2019-04-26
Sent to Provost: 2019-07-24
Sent to Legal:
Completed: 2022-08-08
Requester Name: Lisa Williams
Document 1: https://lewis.gsu.edu/files/2019/09/1441_001.pdf
Document 2:
Document 3:
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Impact Church
Byrdine F Lewis School of Nursing and Health Professions
Erin White
Phone: 404-577-2826
2323 Sylvan Road
East Point GA 30344
Agency Email: erin@impactdcd.org
Expiration Date: 2023-04-30
Sent to Facility: 2020-05-12
Sent to Provost:
Sent to Legal:
Completed: 2020-07-29
Requester Name: Lisa Williams
Document 1: ExpApr2023 ImpactChurch forProvost
Document 2:
Document 3:
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Children’s Healthcare of Atlanta IS & T
Health Informatics
Gina DeShazer
Phone: 404-785-3059
2800 Century Pkway NE 8th Floor
Atlanta Georgia 30345
Agency Email: gina.deshazer@choa.org
Expiration Date: 2020-06-30
Sent to Facility: 2019-04-26
Sent to Provost:
Sent to Legal:
Completed: 2019-05-01
Requester Name: Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: 5/1/19 per Gina DeShazer, MOU with the University System
of Georgia covers all departments and programs at every
affiliated School, so we do not need a separate agreement
for Health Informatics at GSU. As long as the student is
at our facility for course-related credit, the existing
Letter of Agreement is sufficient.
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Integrated Therapy
Department of Physical Therapy
Harriet Adams
Phone: 404-351-5307
2221 Peachtree Road, NE D-336
Atlanta Georgia 30309-1106
Agency Email: harrietadams217@gmail.com
Expiration Date: 2026-06-30
Sent to Facility: 2019-04-26
Sent to Provost: 2019-05-06
Sent to Legal:
Completed: 2023-06-27
Requester Name: Carla Huggins
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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The Beverly J. Searles Foundation, Inc.
Department of Occupational Therapy
Debbie Gallogly
Phone: 404-626-2682
4182 Westchester Trace NE
Roswell Ga 30075
Agency Email: debbie@bjsfoundation.org
Expiration Date: 2025-07-31
Sent to Facility: 2019-04-26
Sent to Provost: 2019-05-09
Sent to Legal:
Completed: 2022-7-28
Requester Name: Jennifer Nelson
Document 1: The Beverly T. Searles Foundation_exp_04-30-2022
Document 2:
Document 3:
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Medical Facilities of America Inc.
Department of Occupational Therapy
Jaime Smiley
Phone: 804 467-7717
2917 Penn Forest Blvd
Roanoke VA 24018
Agency Email: jsmiley@MFA.NET
Expiration Date: Auto Renews
Sent to Facility: 2019-11-14
Sent to Provost:
Sent to Legal: 2019-05-16
Completed:
Requester Name: Shana Finks
Document 1: MFA Auto Renews
Document 2: MFNC Auto Renews
Document 3:
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La Vista Norcross Clinic
Byrdine F Lewis School of Nursing and Health Professions
Juana Braverman
Phone: 770-446-2820
2625 Beaver Ruin Road
Norcross GA 30071
Agency Email: lavistamed@yahoo.com
Expiration Date: 2022-04-30
Sent to Facility: 2022-03-17
Sent to Provost: 2019-05-20
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: 5/15/19 - MOU e-mailed. LYW
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Woodstock Family Practice & Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Hyeon Kang
Phone: 770-726-3601
310 Gold Creek Trail Suite 200
Woodstock GA 30188
Agency Email: wfauc100@gmail.com
Expiration Date: 2022-09-30
Sent to Facility: 2022-09-16
Sent to Provost: 2019-10-22 and 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1:
Document 2: exp sep 2022 ...4122214.pdf
Document 3:
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Star Physical Therapy
Department of Occupational Therapy
Hal Henninger
Phone: 615-591-6590
491 Sage Road N. Suite 1000
White House TN 37188
Agency Email: hal.henninger@starpt.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-26
Requester Name: Shana Finks
Document 1: Star Physical Therapy January 2021
Document 2:
Document 3:
Comment: Sorry for the inconvenience, but please expedite this
contract. The student needs to start January 25th 2021.
MOU signed by Provost. sent to Leon Pegg for signature
Final MOU uploaded 1-26-21
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Connections School of Atlanta Inc.
Occupational Therapy
Michele Kukler
Phone: 404 630 0188 (cell) 404 602 9404 (school)
1017 Edgewood Ave NE
Atlanta Ga 30307
Agency Email: mkukler@connectionsschool.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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Horizon Physical Therapy
Department of Physical Therapy
Daniel McGowan
Phone: 706-548-7300
1360 Caduceus Way Building 200
Watkinsville GA 30677
Agency Email: Dmcgowan@horizonphysicaltherapy.com
Expiration Date: 2022-05-31
Sent to Facility: 2023-03-24
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2019-05-28
Requester Name: Carla Huggins
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
Renewal Submitted No response sent another email 6/08/23
Phone: 706-548-7300
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La Vista Norcross Clinic
Byrdine F Lewis School of Nursing and Health Professions
Juana Braverman
Phone: 770-446-2820
2625 Beaver Ruin Road
Norcross GA 30071
Agency Email: non
Expiration Date:
Sent to Facility: 2022-03-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Final Expires April 2022
Document 2:
Document 3:
Comment: Please forward contract to Lisa Williams
(lwilliams106@gsu.edu) and I will get to the practice.
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Just Us Kids Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Liz Holcomb
Phone: 770-683-5437
2462 Highway 34 East
Newnan GA 30265
Agency Email: frontdesk@justuskidspeds.com
Expiration Date: 2022-05-31
Sent to Facility: 2022-04-21
Sent to Provost: 2019-05-28
Sent to Legal:
Completed: 2019-06-28
Requester Name: Lisa Williams
Document 1: JUST-US-KIDS-PEDIATRICS Expired March2016
Document 2: final expires may 2022
Document 3:
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Clarkston Primary and Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Lydia Lydia Tadesse
Phone: 678-705-9685
4600 E. Ponce De Leon Avenue Suite A
Clarkston GA 30021-1839
Agency Email: clarkstonprimary@gmail.com
Expiration Date: 2025-05-31
Sent to Facility: 2019-05-23
Sent to Provost: 2019-06-17
Sent to Legal:
Completed: 05/31/2022
Requester Name: Lisa Williams
Document 1: Final Expires May 2022
Document 2:
Document 3:
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NMotion Hand Therapy and Physical Therapy
Department of Occupational Therapy
Kyle Oatis
Phone: 678-653-9217
620 Cherokee Street NE
Marietta GA 30060
Agency Email: k.oatis@nmotiontherapy.com
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-23
Requester Name: Karen McWaters
Document 1: ExpMay2023 NMotion_June2020 - signed pdf
Document 2:
Document 3:
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Motion Stability
Department of Physical Therapy
Deanna Camilo
Phone: 404-382-8702
550 Pharr Road NE Suite 550
Atlanta GA 30305
Agency Email: deanna@motionstability.com
Expiration Date: 2026-05-31
Sent to Facility:
Sent to Provost: 2019-06-03
Sent to Legal:
Completed: 2023-03-30
Requester Name: Carla Huggins
Document 1: Final Expires May 2022
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Atlanta Pediatric Partners
Byrdine F Lewis School of Nursing and Health Professions
Carin Lanier
Phone: 404-699-1339
4579 South Cobb Drive Suite 300
Smyrna GA 30080
Agency Email: clanier@atlantapeds.com
Expiration Date:
Sent to Facility: 2022-03-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Integrated Psychiatric Services
Byrdine F Lewis School of Nursing and Health Professions
Sonali Bora
Phone: 678-335-6020
3255 North Point Parkway
Alpharetta GA 30005
Agency Email: sbora@int-psy.com
Expiration Date: 2027-02-28
Sent to Facility: 2024-03-12
Sent to Provost:
Sent to Legal:
Completed: 2024-03-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Daffodil Pediatrics & Family Medicine
School of Nursing
Travis Cradle
Phone: 404.366.3636
4905 Courtney Drive
Forest Park GA 30297
Agency Email: tcradle@goforjw.com
Expiration Date: 2024-06-30
Sent to Facility: 2019-06-03
Sent to Provost:
Sent to Legal: 2019-06-12
Completed: 2021-08-12
Requester Name: Lisa Williams
Document 1: Daffodil Pediatrics & Family
Document 2:
Document 3:
Comment: 6/14/19 Agreement covers both locations (Carrollton and
Forest Park per amendment.
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Gwinnett Hospital System, Inc. ACNP_Gregory Mauldin, MD
School of Nursing
Jennifer Brooks
Phone: 6783123431
100 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: JBrooks@gwinnettmedicalcenter.org
Expiration Date: 2022-05-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: GSU Maulding AGACNP
Document 2:
Document 3:
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Summit BHC Monroe, dba Twin Lakes Recovery Center
BFLCNHP
Karen Cheeseman
Phone: 706-489-6426
398 Hwy 11 SW
Monroe GA 30655
Agency Email: kcheeseman@creativecareconcepts.com
Expiration Date: 2022-06-30
Sent to Facility: 2022-06-01
Sent to Provost: 2019-12-04
Sent to Legal:
Completed: 2019-12-18
Requester Name: Lisa Williams
Document 1: Final Exp June 2022 ...152700pdf
Document 2:
Document 3:
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Body Science RD LLC
Department of Nutrition
Robin Stegall
Phone: 6784626629
11660 Alpharetta Hwy Ste 290
Roswell GA 30076
Agency Email: robinsteagallrd@gmail.com
Expiration Date: 2025-06-30
Sent to Facility: 2019-06-20
Sent to Provost: 2019-08-09
Sent to Legal:
Completed: 2022-06-24
Requester Name: Jessica Todd
Document 1: Final Expires June 2022
Document 2:
Document 3:
Comment: Clinical Agreement
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Northside Forsyth Internal Medicine and Geriatrics
Byrdine F Lewis College of Nursing and Health Professions
Tammy Fontana
Phone: 770-844-0877
1505 Northside Boulevard Suite 2600
Cumming GA 30041
Agency Email: tammyf@nsfimg.com
Expiration Date: 2022-06-30
Sent to Facility: 2019-06-20
Sent to Provost: 2019-06-27
Sent to Legal:
Completed: 2019-06-28
Requester Name: Lisa Williams
Document 1: Final Expires June 30 2022
Document 2:
Document 3:
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Premier Care Family Medicine
BFLCNHP
Etienne Etienne
Phone: 770-771-5235
403 Permian Way Suite A
Villa Rica GA 30180
Agency Email: premiercare01@comcast.net
Expiration Date: 2025-10-31
Sent to Facility: 2019-07-01
Sent to Provost: 2019-08-28
Sent to Legal:
Completed: 2022-10-26
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
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Pediatric Associates of Thomaston
Byrdine F Lewis School of Nursing and Health Professions
Eric Schubert
Phone: 706-646-4543
331 West Main Street Suite 2600
Thomaston GA 30286
Agency Email: ejschubenp@gmail.com
Expiration Date: 2022-06-30
Sent to Facility: 2022-06-01
Sent to Provost: 2019-07-08
Sent to Legal:
Completed: 2019-07-09
Requester Name: Lisa Williams
Document 1: Final Expires June 2022
Document 2:
Document 3:
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Reston Hospital Center - OT
Department of Occupational Therapy
Nicole Lynch
Phone: (703) 689-9286
1850 Town Center Parkway
Reston Va 20190
Agency Email: Nicole.Lynch2@hcahealthcare.com
Expiration Date:
Sent to Facility: 2019-09-04
Sent to Provost:
Sent to Legal: 2019-08-09
Completed:
Requester Name: Carolyn Podolski
Document 1: view
Document 2:
Document 3:
Comment: 7/1/19 To C. Podolski for details on degree and number of
students.
10/24/19 Not pursuing MOU with this facility at this time.
Facility will not accept edits to their contract and C. Lombard
is not ok with it as is.
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Encompass Health Rehabilitation Hospital of Gadsden
Department of Physical Therapy
Rhonda Young
Phone: (256) 439-5000
801 Goodyear Ave
Gadsden AL 35903
Agency Email: Rhonda.Young@encompasshealth.com
Expiration Date: Auto Renews
Sent to Facility: 2020-02-05
Sent to Provost:
Sent to Legal: 2020-01-07
Completed:
Requester Name: Carla Huggins
Document 1: auto renews EncompassGadsdenMOUpdf
Document 2:
Document 3:
Comment: Agency uses their own MOU which is being processed by
their
controller as of 11/12/2019 and will be forwarded to GSU
afterwards.
2/5/20 to facility for final signatures
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Hidden Valley Medical Center dba Blue Ridge Medical Group
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Ewing
Phone: 706-851-4915
101 Riverstone Vista
Blue Ridge GA 30513
Agency Email: jennifer_ewing@quorumhealth.com
Expiration Date:
Sent to Facility: 2019-07-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: This facility operates under Fannin Regional Hospital.
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Pinnacle Orthopedics
Department of Occupational Therapy
Jamey Abbott
Phone: 770-499-9918
300 tower Rd Suite 100
Marietta Ga 30060
Agency Email: Jamey.Abbott@pinnacle-ortho.com
Expiration Date: 2025-07-31
Sent to Facility: 2019-07-09
Sent to Provost: 2019-07-11
Sent to Legal:
Completed: 2022-08-08
Requester Name: Shana Finks
Document 1: Final Expires June 2022
Document 2:
Document 3:
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Orthopedic & Sports Physical Therapy of Cape Cod
Department of Physical Therapy
Dina Qualter
Phone: 774-237-0832
172 Rte 137
Harwich MA 02465
Agency Email: dinaq@osptcc.com
Expiration Date: 2023-07-31
Sent to Facility: 2023-03-24
Sent to Provost: 2020-08-17
Sent to Legal:
Completed: 2020-08-20
Requester Name: Carla Huggins
Document 1: ExpJuly2023 OrthoSportsPT CapeCod forProvost - signed
Document 2:
Document 3:
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Hiller Therapy
Department of Occupational Therapy
Leah Hiller
Phone: 323 641-3662
1137 S Point View St.
Los Angeles CA 90035
Agency Email: leah@hillertherapy.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-02-01
Sent to Provost: 2024-02-26
Sent to Legal:
Completed: 2024-03-06
Requester Name: Karen McWaters
Document 1: Exp June2022 doc03472220191023101905
Document 2:
Document 3:
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Willow Brook
Byrdine F Lewis School of Nursing and Health Professions
Dulnar Bandukwala
Phone: 706-235-5722
314 Shorter Avenue
Rome GA 30168
Agency Email: BandukwalaQMD@bellsouth.net
Expiration Date:
Sent to Facility: 2019-07-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/22/19 On hold. Per Lisa Williams Please place this on the
backburner. The practice is affiliated with Floyd Healthcare and
we have an agreement with them.
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D2kare Prenatal and Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Ann Drayton
Phone: 770-734-0999
6409 Jimmy Carter Boulevard Suite 900
Norcross GA 30071
Agency Email: D2kareservices@gmail.com
Expiration Date: 2026-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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McKenna Farms Therapy Services
Department of Occupational Therapy
Ashley Burdette
Phone: 706 498 7993
3044 Due west Rd
Dallas Ga 30157
Agency Email: aburdette@mckennafarms.org
Expiration Date: 2025-07-31
Sent to Facility: 2019-07-11
Sent to Provost: 2019-07-12
Sent to Legal:
Completed: 2022-08-08
Requester Name: Shana Finks
Document 1: Final Expires June 2022
Document 2:
Document 3:
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The Maryland School for the Blind
Department of Occupational Therapy
Lynn Borgmann
Phone: 410 444 5000 ext. 1342
3501 Taylor Avenue
Baltimore MD 21236
Agency Email: lynnb@mdschblind.org
Expiration Date: 2022-07-31
Sent to Facility: 2022-08-01
Sent to Provost: 2019-07-31
Sent to Legal:
Completed: 2019-08-28
Requester Name: Karen McWaters
Document 1: Final Expires July 2022
Document 2:
Document 3:
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Children Under Construction
BFLCNHP/Perimeter College Department of Nursing.
Sammie Osinuga
Phone: 7702744667
5148 Memorial Drive
Stone Mountain GA 30083
Agency Email: sammieosinuga@yahoo.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-06-15
Sent to Provost: 2019-08-12
Sent to Legal:
Completed: 2019-08-29
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
Comment: Please create this agreement in the same format as was
completed for Wings of a Dove Christian Academy.
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EBS Healthcare
Department of Occupational Therapy
Jay Mazza
Phone: 1-800-578-7906 ext. 218
200 Skiles Blvd
West Chester PA 19382
Agency Email: jay.mazza@ebshealthcare.com
Expiration Date:
Sent to Facility: 2019-08-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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The Groover Clinic
Byrdine F Lewis School of Nursing and Health Professions
Ann Groover
Phone: 706-602-9234
2945 Miller Ferry Road, SW
Calhoun GA 30701
Agency Email: grooverclinic@live.com
Expiration Date: 2025-07-31
Sent to Facility: 2019-08-07
Sent to Provost: 2019-08-08
Sent to Legal:
Completed: 2022-07-22
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
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ChoiceOne Urgent Care of Gwinnett, LLC.
Byrdine F Lewis College of Nursing and Health Professions
Sarah Munier
Phone: 410-648-9104
1400 Front Ave Suite 300
Lutherville Timonium MD 21093
Agency Email: sarah.munier@choiceoneuc.com
Expiration Date: 2022-08-31
Sent to Facility: 2022-07-19
Sent to Provost: 2019-09-11
Sent to Legal: 2019-08-30
Completed: 2019-10-14
Requester Name: Lisa Williams
Document 1: Final Expires August 2022
Document 2:
Document 3:
Comment: 9/11/19 C. Lombard approved edits. To provost for signature.
9/17/19 to facility for final signatures
(database note: 10/16 overrode doc 1 with corrected 7 page
document)
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Developmental & Rehabilitative Service II, Inc
Department of Physical Therapy
Katrina Bernard
Phone: 770-679-1553
2395 Wall Street Suite 176
Conyers GA 30013
Agency Email: Info@devrehabpt2.com
Expiration Date: 2025-07-31
Sent to Facility: 2019-08-09
Sent to Provost: 2020-01-22
Sent to Legal:
Completed: 2022-08-02
Requester Name: Carla Huggins
Document 1: exp july 2022 ...4122535.pdf
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
Dr. Denise Edwards, DPT is the president who will be
signing all
required documents.
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Lakeview Behavioral Health
Byrdine F Lewis School of Nursing and Health Professions
William Benifield
Phone: 770-766-7006
1 Technology Parkway South
Norcross GA 30092
Agency Email: William.benifield@lakeviewbehavioralhealth.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-06-15
Sent to Provost: 2019-08-14
Sent to Legal:
Completed: 2019-08-29
Requester Name: Lisa Williams
Document 1: Final Expires July 2022
Document 2:
Document 3:
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Windy Therapy Services Inc.
Department of Occupational Therapy
Windy Cruz
Phone: 404-617-0428
4962 Falcon Wood Court
Marietta 30066 Ga 30066
Agency Email: windyot@icloud.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-08-01
Sent to Provost: 2019-08-23
Sent to Legal:
Completed: 2019-08-29
Requester Name: Jennifer Nelson
Document 1: Final Expires July 2022
Document 2:
Document 3:
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InterPlay Occupational Therapy for Children
Department of Occupational Therapy
Michelle Young
Phone: 561 450-5080
3066 Jog Road
Greenacres FL 33467
Agency Email: michelle@interplaytherapy.com
Expiration Date: 2022-07-31
Sent to Facility: 2022-08-01
Sent to Provost: 2019-08-16
Sent to Legal:
Completed: 2019-08-29
Requester Name: Jennifer Nelson
Document 1: view
Document 2:
Document 3:
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Loudoun County Public Schools
Department of Occupational Therapy
Dawn Taylor
Phone: 571-252-1270
21000 Education Court
Ashburn, VA 20180
Agency Email: Dawn.Taylor@lcps.org
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal: 2024-04-10
Completed: 2020-01-02
Requester Name: Karen McWaters
Document 1: Exp June 2024 ...LoudonCoPS.pdf
Document 2: view
Document 3:
Comment: 12/16/19 to facility for final signatures
Kelly Briner, Risk Manager
Loudoun County Public Schools
21000 Education Court
Ashburn, Va 20180
571-252-1270
kelly.briner@lcps.org
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Loudoun County Public Schools
Department of Occupational Therapy
Kelly Briner
Phone: 571-252-1270
21000 Education Court
Ashburn, VA 20180
Agency Email: kelly.briner@lcps.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1: Exp June 2024 ...LoudonCoPS.pdf
Document 2: view
Document 3:
Comment: kelli,
This was sent back in June 27 and I did not fill out the
request. I just found your old email. So here it is.
Sorry aobut that. Thanks!!
Dear Kelli and Carolyn-
Please see the attached for the Georgia State University OT
Intern Affiliation MOU with LCPS. Please
review, have it initialed at the bottom of each page,
signed on page 5, and return it to me by email for
processing.
We will return the countersigned MOU for your file
archives.
Many thanks for your help and please let us know if you
have any questions in the meantime. Best! Kelly
Kelly Briner, Risk Manager
Loudoun County Public Schools
21000 Education Court
Ashburn, Va 20180
571-252-1270
kelly.briner@lcps.org
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WHASN Desert Inn
Byrdine F Lewis School of Nursing and Health Professions
Tikva Butler
Phone: 702-796-9997
2860 E. Desert Inn Road
Las Vegas NV 89121
Agency Email: Tikvabutler@gmail.com
Expiration Date: 2022-08-31
Sent to Facility: 2019-08-22
Sent to Provost: 2019-09-13 and 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp aug 2022 ...4122431.pdf
Document 2:
Document 3:
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Wellspring Living
Department of Occupational Therapy
Kendra Hanson
Phone: 678-718-8151
1040 Boulevard SE Suite M
Atlanta Ga 30312
Agency Email: khanson@wellspringliving.org
Expiration Date: 2022-08-31
Sent to Facility: 2022-09-15
Sent to Provost: 2019-08-28
Sent to Legal:
Completed: 2019-09-24
Requester Name: Karen McWaters
Document 1: Final Expires August 2022
Document 2:
Document 3:
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Disability Action Center of Georgia Inc., dba disABILITY LINK
Department of Occupational Therapy
Kim Gibson
Phone: 404-687-8890 ext. 102
1901 Montreal Road Suite 102
Tucker Ga 30084
Agency Email: kgibson@disabilitylink.org
Expiration Date:
Sent to Facility: 2019-08-28
Sent to Provost: 2019-09-10
Sent to Legal:
Completed: 2019-09-16
Requester Name: Carolyn Podolski
Document 1: Final Expires August 2022
Document 2:
Document 3:
Comment: Last one I am trying to get rushed. Thanks
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Jeffrey l Winston, MD
BFLCNHP
Jeffrey Winston
Phone: 770-457-7994
4546 Barclay Drive Suite B
Dunwoody GA 30338
Agency Email: jwinstonmd@icloud.com
Expiration Date: 2022-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2016-09-16
Sent to Legal:
Completed: 2019-09-19
Requester Name: Lisa Williams
Document 1: Final Expires August 2022
Document 2:
Document 3:
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The Hand and Upper Extremity Rehabilitation Center LLC
Department of Occupational Therapy
Christine Peters
Phone: 404 255 1242
980 Johnson Ferry Rd NE Suite 1000
Atl Ga 30342
Agency Email: c.peters@handcenterga.com
Expiration Date: 2022-08-31
Sent to Facility: 2022-08-01
Sent to Provost: 2019-09-16
Sent to Legal:
Completed: 2019-09-29
Requester Name: Jennifer Nelson
Document 1: Final Expires August 2022
Document 2:
Document 3:
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Psychiatric Professionals of Georgia
Byrdine F Lewis College of Nursing and Health Professions
Hope Fettler
Phone: 706-429-7373
1490 Distribution Drive Suite 150
Suwanee GA 30024
Agency Email: hfettler@gmail.com
Expiration Date: 2025-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-12-16
Sent to Legal:
Completed: 2022-8-08
Requester Name: Lisa Williams
Document 1: Final Expires August 2022 ...152637pdf
Document 2:
Document 3:
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Primary Care Physicians of Atlanta
Byrdine F Lewis College of Nursing and Health Professions
Sandra Banks
Phone: 404-255-9100
5670 Peachtree Dunwoody Road Suite 1200
Atlanta GA 30342
Agency Email: skbgois@aol.com
Expiration Date: 2025-08-31
Sent to Facility: 2019-09-13
Sent to Provost: 2019-09-18
Sent to Legal:
Completed: 2022-08-30
Requester Name: Lisa Williams
Document 1: Final Expires August 2022
Document 2:
Document 3:
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Primary Care Pediatrics, P.C.
Byrdine F Lewis School of Nursing and Health Professions
Amanda Kern
Phone: 678-478-0167
763 Peachtree Parkway Suite 2
Cumming GA 30041
Agency Email: office@primarycarepediatrics.com
Expiration Date: 2022-08-31
Sent to Facility: 2022-09-16
Sent to Provost: 2019-10-17
Sent to Legal:
Completed: 2019-10-23
Requester Name: Lisa Williams
Document 1: Exp Aug 2022 doc03472020191023101822
Document 2:
Document 3:
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Pediatric Associates of Lawrenceville
Byrdine F Lewis School of Nursing and Health Professions
Michelle Dixon
Phone: 770-277-6725
738 Old Norcross Road
Lawrenceville GA 30046
Agency Email: mldixon0927@gmail.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Modern Internal Medicine Urgent and Primary Care
Byrdine F Lewis School of Nursing and Health Professions
Rosalyn Primus
Phone: 678-515-8154
2457 Martin Luther King Jr Dr SW Unit A
A GA 30311
Agency Email: Rosalyn@mimurgentcare.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Marietta West Cobb Counseling Center, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Terri Abraham
Phone: 770-415-0880
707 Whitlock Avenue SW Suite H-10
Marietta GA 30064
Agency Email: TerriAbraham@MariettaCounselingCenter.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:
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Exceptional Insights Group LLC
Department of Occupational Therapy
Heather Radlmann
Phone: 404-394-1969
245 N. Highland Ave NE Suite 230-367
Atlanta Ga 30307
Agency Email: h.radlmann@gmail.com
Expiration Date:
Sent to Facility: 2019-09-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Hi Kelli,
Just the normal contract, no rush!
Thanks!
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SynsorMed
Health Informatics
Amin Holmes
Phone: 404-822-4686
2451 Cumberland Parkway Suite 3755
Atlanta Georgia 30339
Agency Email: aholmes@synsormed.com
Expiration Date: 2022-09-30
Sent to Facility: 2019-09-26
Sent to Provost: 2019-10-02
Sent to Legal:
Completed: 2019-10-08
Requester Name: Cedric Truss
Document 1: Final Expires September 2022
Document 2:
Document 3:
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Eastside Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Adrienne Gasper
Phone: 770-982-0255
2311 Henry Clower Boulevard Suite D
Snellville GA 30078
Agency Email: Agasper.eastside@yahoo.com
Expiration Date: 2022-08-31
Sent to Facility: 2022-07-19
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:
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Kidz Therapy Networks
Department of Occupational Therapy
Meghan Panagopoulos
Phone: 770-205-5551
5000 research ct suite 450
Suwanee Georgia 30024
Agency Email: meghan@kidztherapynetworks.com
Expiration Date: 2022-09-30
Sent to Facility: 2022-08-09
Sent to Provost: 2019-12-04
Sent to Legal:
Completed: 2019-12-04
Requester Name: Karen McWaters
Document 1: Final Expires Sep 2022 ...93439pdf
Document 2:
Document 3:
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Hill Country Family Clinic
Byrdine F Lewis School of Nursing and Health Professions
Maria Hooper
Phone: 512-991-5570
400 W US Hwy 290 Suite B 105
Dripping Springs TX 78620
Agency Email: mar2002a@yahoo.com
Expiration Date: 2024-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-07-29
Requester Name: Lisa Williams
Document 1: Hill Country Family Clinic
Document 2:
Document 3:
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North Pointe OB/GYN of Cumming, LLC
Byrdine F Lewis School of Nursing and Health Professions
Kawonaca Washington
Phone: 770-886-3555 x1195
1800 Northside Forsyth Drive, Suite 350
Cumming GA 30041
Agency Email: Kawonaca@npobgyn.com
Expiration Date: 2022-09-30
Sent to Facility: 2022-09-16
Sent to Provost: 2019-10-25
Sent to Legal:
Completed: 2019-10-29
Requester Name: Lisa Williams
Document 1: Final Expires September 2022
Document 2:
Document 3:
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Malinda Graham & Associates, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Malinda Graham
Phone: 912-559-5536
5105 Paulsen Street
Savannah GA 31405
Agency Email: lgraham@mgrahaminc.com
Expiration Date: 2025-09-30
Sent to Facility: 2019-10-02
Sent to Provost: 2019-10-08
Sent to Legal:
Completed: 2022-10-19
Requester Name: Lisa Williams
Document 1: Exp Sept 2022 doc03471820191023101718
Document 2:
Document 3:
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Heali
Department of Nutrition
Renee Fitton
Phone: 310-430-3824
1431 Ocean Ae 300
Santa Monica CA 90401
Agency Email: renee@heali.ai
Expiration Date: 2025-10-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-22
Sent to Legal:
Completed: 2022-08-18
Requester Name: Jessica Todd
Document 1: Exp Oct 2022 doc03472620191023102030
Document 2:
Document 3:
Comment: non clinical
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Fulton County School Nutrition Program
Department of Nutrition
Alyssia Wright
Phone: 404-669-8195
6201 Powers Ferry Rd. NW
Atlanta Ga 30339
Agency Email: wrightal@fultonschools.org
Expiration Date: auto renews
Sent to Facility: 2020-01-21
Sent to Provost:
Sent to Legal: 2020-01-06
Completed: 2020-01-23
Requester Name: jessica todd
Document 1: auto renews ...GSUpdf...
Document 2:
Document 3:
Comment: Non Clinical Agreement
1/21/20 to facility for final signature
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Walden Behavioral Care
Department of Nutrition
Lindsay Lipton
Phone: 9494126170
4536 Barclay Dr
Dunwoody GA 30338
Agency Email: llipton@waldenbehavioralcare.com
Expiration Date: 2022-10-31
Sent to Facility: 2022-08-09
Sent to Provost: 2020-01-08
Sent to Legal:
Completed: 2020-01-14
Requester Name: Jessica Todd
Document 1: Exp Oct 2022 ...113104.pdf
Document 2:
Document 3:
Comment: Clinical Agreement- 1/27/23 Sent another request
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St. Francis Health, LLC d/b/a St. Francis Hospital
Byrdine F Lewis School of Nursing and Health Professions
Tricia Hamid
Phone: 706.596.4032
2122 Manchester Expressway
Columbus GA 31904
Agency Email: hamidt@sfhga.com
Expiration Date: No expiration date
Sent to Facility: 2020-01-21
Sent to Provost: 2019-12-13
Sent to Legal: 2019-10-25
Completed: 2020-03-02
Requester Name: Lisa Williams
Document 1: auto renews SFH Georgia State U pdf
Document 2:
Document 3:
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White-Wilson Medical Center, P.A.
Byrdine F Lewis School of Nursing and Health Professions
Brigitte Sullivan
Phone: 850-863-8131 x8502
1005 Mar-Walt Drive
Fort Walton Beach FL 32547-6796
Agency Email: bsullivan@white-wilson.com
Expiration Date: 2023-08-16
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/26/22 Contract auto renews annually. LYW
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West Georgia Cardiology Associates
Byrdine F Lewis School of Nursing and Health Professions
Candice Brown
Phone: 770-838-8440
129 Bankhead Highway
Carrollton GA 30117
Agency Email: cbrown@westgacardiology.com
Expiration Date: 2025-10-31
Sent to Facility: 2019-10-17
Sent to Provost: 2019-10-22
Sent to Legal:
Completed: 2023-01-04
Requester Name: Lisa Williams
Document 1: Exp Oct 2022 doc03472520191023102009
Document 2:
Document 3:
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Breakthrough Recovery Outreach
Byrdine F Lewis School of Nursing and Health Professions
Tameka Harris-James
Phone: 770-493-7750
3648 Chamblee Tucker Road Suite F
Atlanta GA 30341
Agency Email: tharrisjames@my-breakthrough.com
Expiration Date: 2022-10-31
Sent to Facility: 2022-10-31
Sent to Provost: 2019-11-11
Sent to Legal:
Completed: 2019-11-11
Requester Name: Lisa Williams
Document 1: Exp Oct 2022 ...8105354pdf
Document 2:
Document 3:
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Suburban Womens Specialists
Byrdine F Lewis School of Nursing and Health Professions
Bonnie Hoag
Phone: 770-766-1498
6300 Hospital Parkwayy Suite 200
Johns Creek GA 30097
Agency Email: bhoag1@hotmail.com
Expiration Date: 2022-10-31
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 Oct 2022 140423
Document 2:
Document 3:
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Whitley Pediatric ENT
Byrdine F Lewis School of Nursing and Health Professions
Crystal Henson
Phone: 770-691-9000
12020 Etris Road Suite B-140
Roswell GA 30075
Agency Email: chenson@entofga.com
Expiration Date: 2025-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Four Corners Primary Care Centers
Brian Williams
Phone: 706-684-0651
5300 Oakbrook Parkway Building 100. Suite 130
Norcross GA 30093
Agency Email: lturriago@fcpchealth.org
Expiration Date: 2023-05-31
Sent to Facility: 2020-05-28
Sent to Provost: 2020-06-30
Sent to Legal:
Completed: 2020-08-10
Requester Name: Lisa Williams
Document 1: ExpMar2023 FourCornersPrimaryCare forProvost signed pdf
Document 2:
Document 3:
Comment: Contact person: HR Coordinator Laura Turriago
lturriago@fcpchealth.org
Dr. Brian Williams is the Chief Exec Officer. FCPC has 3
locations, Norcross (Main Office), Lawrenceville and
Hoschton
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Encore Rehabilitation Services, LLC d/b/a Eastcastle Place
Department of Occupational Therapy
Lindsey Viegut
Phone: 414-977-8539
2505 E Bradford Avenue
Milwaukee WI 53211
Agency Email: lviegut@eastcastleplace.com
Expiration Date:
Sent to Facility: 2020-02-11
Sent to Provost: 2020-02-13
Sent to Legal: 2020-01-23
Completed:
Requester Name: Shana Finks
Document 1: EncoreEastcastle AutoRenews ...9170508pdf
Document 2:
Document 3:
Comment: Encore Rehab is the contracting company. Laura Sostre is
the contact for contracts ;
Laura A. Sostre, OTR, MPHW
Clinical Fieldwork Coordinator
Tel: 724-925-8505 Ext. 116 | Fax: 920-227-9597
33533 W. 12 Mile Road Suite 290 | Farmington, MI 48331
2/10/2020 Provost signed, to facility for final
signatures
2/13/2020 Facility signed and incorporated our changes
into their electronic document which subsequently wiped
out the provost signature, back to provost for final
signature.
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Wellroot Family Services
Department of Nutrition
Leisa White
Phone: 404-327-5820
1967 Lakeside Parkway Suite 400
Tucker GA 30084
Agency Email: lwhite@wellroot.org
Expiration Date: 2027-02-28
Sent to Facility: 2024-03-07
Sent to Provost: 2024-03-19
Sent to Legal:
Completed: 2024-03-30
Requester Name: Jessica Alexander-White
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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South University - Savannah
Byrdine F Lewis School of Nursing and Health Professions
Deborah Samay
Phone: 912-201-8000
1250 Penn Avenue
Pittsburgh PA 15222
Agency Email: AffiliationAgreements@southuniversity.edu
Expiration Date:
Sent to Facility: 2020-02-20
Sent to Provost: 2020-01-06
Sent to Legal:
Completed: 2020-02-27
Requester Name: Lisa Williams
Document 1: South University - Savannah, GA
Document 2:
Document 3:
Comment: 11/12- fwd agreement to C. Lombard for review. LYW
11/13 also sent printed to kisha
2/13/20 left message inquiring with Kisha
2/27/20 - final
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Therapy Works, PC
Department of Occupational Therapy
Aileen Deogracias
Phone: (770)995-2379
1509 Atkinson Rd. Suite 1100
Lawrenceville GA 30043
Agency Email: aileen.deogracias@therapyworkspc.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-25
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Generations Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Katherine Vickers
Phone: 725-251-6390
8225 W.Sahara Avenue Suite C
Las Vegas NV 89117
Agency Email: Kvickers@mystbeautybar.com
Expiration Date: 2022-11-30
Sent to Facility: 2019-11-22
Sent to Provost: 2020-01-14
Sent to Legal:
Completed: 2020-01-17
Requester Name: Lisa Williams
Document 1: exp nov 2022 GenerationsMedCenter...pdf
Document 2:
Document 3:
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Pandya Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Mindy Roark
Phone: 770-373-7704
3970 Deputy Bill Cantrell Memorial Road Suite 220
Cumming GA 30040
Agency Email: mroark@pandyamedicalcenter.com
Expiration Date: 2023-07-31
Sent to Facility: 2023-06-13
Sent to Provost: 2020-08-17
Sent to Legal:
Completed: 2020-08-20
Requester Name: Lisa Williams
Document 1: ExpJul2023 PandyaMedCenter forProvost - signed
Document 2:
Document 3:
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Kids N Motion
Department of Occupational Therapy
Dvora Zibitt
Phone: (404) 353-6249
7100 Peachtree Dunwoody Rd 220
Atlanta GA 30328
Agency Email: kidsnmotionatl@gmail.com
Expiration Date: 2022-11-30
Sent to Facility: 2022-09-19
Sent to Provost: 2020-01-28
Sent to Legal:
Completed: 2020-02-11
Requester Name: Jennifer Nelson
Document 1: exp nov 2022 ...213165142pdf
Document 2:
Document 3:
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Premier Childrens Therapy Center
Department of Occupational Therapy
Leah Planchard
Phone: 770-641-8070
1000 Holcomb Woods Parkway Bldg 400, Suite #422
Roswell GA 30076
Agency Email: dmclaughlin@premierctc.com
Expiration Date: 2025-10-31
Sent to Facility: 2019-11-21
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2022-09-26
Requester Name: Jennifer Nelson
Document 1: exp oct 2022 ...4122321.pdf
Document 2:
Document 3:
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Creekview Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Anna Vitucci
Phone: 770-622-7742
3925 Johns Creek Court Suite D
Suwannee GA 30024
Agency Email: creekviewpediatrics@gmail.com
Expiration Date: 2022-11-30
Sent to Facility: 2022-11-03
Sent to Provost:
Sent to Legal:
Completed: 2020-01-14
Requester Name: Lisa Williams
Document 1: exp nov 2022 ...113125.pdf
Document 2:
Document 3:
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Marathon Health, LLC
Byrdine F Lewis School of Nursing and Health Professions
Christine Ritchey
Phone: 814-329-9142
20 Winooski Falls Way Suite 400
Winooski VT 05404
Agency Email: critchey@marathon-health.com
Expiration Date: 2022-11-30
Sent to Facility: 2022-11-03
Sent to Provost: 2019-12-18
Sent to Legal:
Completed: 2019-12-19
Requester Name: Lisa Williams
Document 1: exp nov 2022 ...113500.pdf
Document 2:
Document 3:
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Encompass Health Lakeshore Rehabilitation Hospital
Department of Physical Therapy
Kathy Bessiere
Phone: (205) 868-2000
3800 Ridgeway Dr
Birmingham AL 35209
Agency Email: Kathy.Bessiere@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-09-15
Sent to Provost: 2020-04-03
Sent to Legal: 2020-03-19
Completed: 2020-05-01
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW sent a direct request to site
to initiate process.
4/3/20 Lombard e-route to provost for signature
9/15/20 to facility for final signatures
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Encompass Health Rehabilitation Hospital of Montgomery
Department of Physical Therapy
Kim McDaniel
Phone: (334) 284-7700
4465 Narrow Lane Rd
Montgomery AL 36116
Agency Email: Kim.McDaniel@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-09-03
Sent to Provost: 2020-04-03
Sent to Legal: 2020-03-06
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW initiated a request directly
with the site.
4/3/20 C. Lombard routed to provost electronically for
signature
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Encompass Health Rehabilitation Hospital of Sunrise, LLC
Department of Occupational Therapy
Deven Silverman
Phone: (954) 749-0300
4399 N Nob Hill Rd
Sunrise FL 33351
Agency Email: Deven.Silverman@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-09-15
Sent to Provost: 2020-07-06
Sent to Legal: 2020-06-19
Completed: 2020-09-16
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
Comment: Would like to renew with MOU covering both PT and OT programs.
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Encompass Health Rehabilitation Hospital of Savannah
Department of Physical Therapy
Becky Augustyniak
Phone: (800) 622-7269
6510 Seawright Dr
Savannah GA 31406
Agency Email: Becky.Augustyniak@encompasshealth.com
Expiration Date:
Sent to Facility:
Sent to Provost: 2020-04-03
Sent to Legal: 2020-03-26
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW contacted site directly to
initiate agreement.
3/26 to C. Lombard for review
4/3/20 C. Lombard e-route to provost for signature
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Walton Rehabilitation Hospital, an affiliate of Encompass Health
Department of Physical Therapy
Terrie Richardson
Phone: (706) 724-7746
1355 Independence Dr
Augusta GA 30901
Agency Email: Terrie.Richardson@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-02-20
Sent to Provost:
Sent to Legal: 2020-01-16
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW contacted site directly to
initiate agreement.
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The Rehabilitation Institute of St. Louis, an affiliation of BJC HealthCare and Encompass Health
Department of Physical Therapy
Michelle Sago
Phone: 314.658.3800
4455 Duncan Ave.
St. Louis MO 63110
Agency Email: michelle.sago@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-03-04
Sent to Provost:
Sent to Legal: 2020-02-04
Completed: 2020-04-22
Requester Name: Carla Huggins
Document 1: Georgia State University Contract pdf
Document 2:
Document 3:
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Encompass Health Rehabilitation Hospital of Bluffton
Department of Physical Therapy
Kelly Gore
Phone: (843) 836-8200
107 Seagrass Station Rd
Bluffton SC 29910
Agency Email: Kelly.Gore@encompasshealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW contacted site directly to initiate agreement.
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Encompass Health Rehabilitation Hospital of Charleston
Department of Physical Therapy
Susan Trantham
Phone: (843) 820-7777
9181 Medcom St
Charleston SC 29406
Agency Email: Susan.Trantham@encompasshealth.com
Expiration Date: Auto Renews
Sent to Facility: 2020-02-05
Sent to Provost:
Sent to Legal: 2019-12-19
Completed: 2020-02-11
Requester Name: Carla Huggins
Document 1: EncompassCharleston AutoRenews
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW contacted site directly to
initiate agreement.
2/5/20 to facility for final signatures
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Encompass Health Rehabilitation Hospital of Chattanooga dba Rebound LLC
Department of Physical Therapy
Teesha Kile
Phone: (423) 698-0221
2412 McCallie Ave
Chattanooga TN 37404
Agency Email: Teesha.Kile@encompasshealth.com
Expiration Date: 2021-04-30
Sent to Facility:
Sent to Provost: 2020-05-08
Sent to Legal: 2020-04-17
Completed: 2020-06-16
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Agency uses their own MOU. MW contacted site directly to
initiate agreement.
6/15/20 Provost signed. To Masiki to send to facility for
signatures.
COMPLETE - One year term.
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Encompass Health Rehabilitation Hospital of The Woodlands
Department of Physical Therapy
Valerie Wells
Phone: (281) 364-2000
18550 I-45
Conroe TX 77384
Agency Email: Valerie.Wells@encompasshealth.com
Expiration Date: 2027-01-0
Sent to Facility:
Sent to Provost: 2024-01-02
Sent to Legal:
Completed: 2024-01-12
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sent partially exec agreement to Facility 1/11/2024
Agency uses their own MOU. MW contacted site directly to
initiate agreement.
Effective date 01-02-2024
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Decatur Hand and Physical Therapy Specialists
Department of Occupational Therapy
Rachele Branson
Phone: (404) 296-8511
141 Sam Street Suite A
Decatur GA 30030
Agency Email: rbranson@usphclinic.com
Expiration Date: 2022-11-30
Sent to Facility: 2019-11-22
Sent to Provost: 2020-01-07
Sent to Legal:
Completed: 2020-01-14
Requester Name: Shana Finks
Document 1: Decatur Hand and Physical Therapy Specialists
Document 2:
Document 3:
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Georgia Bone and Joint, LLC
Department of Physical Therapy
Kevin Smith
Phone: 770-254-7850
1755 Hwy 34 E Suite 1300
Newnan GA 30265
Agency Email: ksmith@gbandj.com
Expiration Date: 2026-04-30
Sent to Facility: 2019-11-22
Sent to Provost: 2020-01-24
Sent to Legal:
Completed: 2023-04-04
Requester Name: Carla Huggins
Document 1: exp nov 2022 ...4122611.pdf
Document 2:
Document 3:
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Jeter Rehab Therapy
Department of Occupational Therapy
Emily Jeter
Phone: 202-528-7223
1025 Connecticut Ave NW Suite 417
Washington DC 20036
Agency Email: JeterRehab@aol.com
Expiration Date: 2027-02-28
Sent to Facility: 2022-09-19
Sent to Provost: 2024-03-20
Sent to Legal:
Completed: 2024-03-20
Requester Name: Karen McWaters
Document 1: exp nov 2022 ...113024.pdf
Document 2:
Document 3:
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Northside Hospital Gwinnett ACNP_Lance B. Friedland MD
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Brooks
Phone: 678-312-3431
100 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: jennifer.brooks.nh@gmail.com
Expiration Date: 2021-12-31
Sent to Facility: 2019-12-16
Sent to Provost: 2019-12-13
Sent to Legal: 2019-11-22
Completed: 2020-01-09
Requester Name: Lisa Williams
Document 1: GSU Friedland AGACNP 12 31 2021
Document 2: Exp Dec 2021 ...GSU Friedland AGACNP 123121.pdf
Document 3:
Comment: 1/22/2020 final contract received. LYW
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PreMedex
Health Informatics
Jim Bowling
Phone: 678-285-3011
6190 Powers Ferry Road 310
Atlanta Georgia 30339
Agency Email: jim@premedex.net
Expiration Date: 2022-12-31
Sent to Facility: 2019-12-18
Sent to Provost:
Sent to Legal:
Completed: 2020-01-14
Requester Name: Dr. Cedric Truss
Document 1: exp dec 2022 ...113307.pdf
Document 2:
Document 3:
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Blendz Therapy
Department of Occupational Therapy
Lauren Friedman
Phone: 818-521-9262
12345 Marshall Street Unit 11
Culver City CA 90230
Agency Email: info@blendztherapy.org
Expiration Date: 2022-12-31
Sent to Facility: 2022-09-19
Sent to Provost: 2020-01-07
Sent to Legal:
Completed: 2020-01-14
Requester Name: Jennifer Nelson
Document 1: exp dec 2022 ...113229.pdf
Document 2:
Document 3:
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William McGarity Jr MD PC
Byrdine F Lewis School of Nursing and Health Professions
Mary Griffom
Phone: 770-981-3511
5243 Snapfinger Woods Drive Suite 103
Decatur GA 30035
Agency Email: mcgaritystaff@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2019-12-18
Sent to Provost: 2020-01-30
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...4122301.pdf
Document 2:
Document 3:
Comment: 1/14/20 Facility sending signed agreement via USPS
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Peachstate Psychiatric Services
Byrdine F Lewis School of Nursing and Health Professions
James Belk
Phone: 404-381-1973
1720 Peachtree Street NW Suite 640
Atlanta GA 30309
Agency Email: jbelk@drowensmd.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-08
Sent to Legal:
Completed: 2020-01-14
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...113044.pdf
Document 2:
Document 3:
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Beyond Limits Pediatric Therapy Center
Department of Occupational Therapy
Madison Kidd
Phone: 770-917-5737
4900 Ivey Road Suite 1720
Acworth GA 30101
Agency Email: madison@beyondlimitstherapy.org
Expiration Date: 2025-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-02-05
Sent to Legal: 2024-03-20
Completed: 2022-10-27
Requester Name: Karen McWaters
Document 1: exp dec 2022 Beyond LimitsPeds
Document 2:
Document 3:
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Encompass Health - Home Health Marietta
Department of Occupational Therapy
Latonya Carter
Phone: 678-354-1456
1000 Cobb Pl Blvd NW Suite 310
Kennesaw GA 30144
Agency Email: latonya.carter@encompasshealth.com
Expiration Date:
Sent to Facility: 2020-02-21
Sent to Provost:
Sent to Legal: 2020-01-06
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: 2/21/20 to facility with redlines
5/29/20 Facility denied changes
6/4/20 C. Lombard reached out to facility requesting
phone conversation
8/31/20 fwd to Melana McClatchey in legal for update,
Melana reached out to facility again
9/1/20 per Shalondria Wilkerson, Contracts Facilitator this
facility is not taking students at this time due to covid.
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University of Utah
Department of Nutrition
Kelsey Smith
Phone: 678-908-8018
580 S Guardsman Way
Salt Lake City UT 84108
Agency Email: ksmith@huntsman.utah.edu
Expiration Date: 2026-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-27
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Sugarloaf Medical, PC
Byrdine F Lewis School of Nursing and Health Professions
Shukri George Makhlouf
Phone: 770-831-3018
1300 Peachtree Industrial Boulevard Suite4203
Suwanee GA 30024
Agency Email: Shukrimakhloufmd@sugarloafmedical.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-09
Sent to Legal:
Completed: 2020-01-14
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...113003.pdf
Document 2:
Document 3:
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Select Specialty Hospital – Midtown, Atlanta, LLC
Byrdine F Lewis School of Nursing and Health Professions
Adam Principe
Phone: (404) 873-2871
705 Juniper Street NE
Atlanta GA 30308
Agency Email: APrincipe@selectmedical.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: Final signed copies to be sent to
THE HOSPITAL:
Select Specialty Hospital – Midtown, Atlanta, LLC
705 Juniper Street NE
Atlanta, GA 30308
Attn: Chief Executive Officer
With a copy to:
Select Medical Corporation
4714 Gettysburg Road
P.O. Box 2034
Mechanicsburg, PA 17055
Attn: Melinda C. Bechtel, Vice President
& Senior Counsel, Hospital Operations
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GardaWorld Federal Services - Childrens Camp
Byrdine F Lewis School of Nursing and Health Professions
Reef Gillum
Phone: 564-217-3853
4217 NW 61st Court
Coconut Creek FL 33073
Agency Email: Reef.gillum@garda-federal.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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My Family Clinic
Byrdine F Lewis School of Nursing and Health Professions
Erroll Wilson
Phone: 760-342-4200
81709 Doctor Carreon Boulevard Suite C5
Indio CA 99201
Agency Email: myfamilyclinic15@gmail.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-08
Sent to Provost: 2020-01-09
Sent to Legal:
Completed: 2020-01-14
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...113714.pdf
Document 2:
Document 3:
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Peachstate Family Clinic
Byrdine F Lewis School of Nursing and Health Professions
Changchun Wu
Phone: 678-583-8888
4319 Lawrence Hwy NW
Lilburn GA 30047
Agency Email: peachstatefamilyclinic@gmail.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Rock Primary Care & Wellness Clinic
Kimberly Fitzgerald
Phone: 770-864-5020
5385 Five Forks Trickum Road
Stone Mountain GA 30087
Agency Email: rockprimarycare@gmail.com
Expiration Date: 2026-06-30
Sent to Facility: 2020-06-25
Sent to Provost:
Sent to Legal:
Completed: 2023-10-06
Requester Name: Lisa Williams
Document 1: ExpJun2023 RockPrimary forProvost signed
Document 2:
Document 3:
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Good Samaritan Health Center of Cobb
Byrdine F Lewis School of Nursing and Health Professions
Aime Piligian
Phone: 770-419-3120 x176
1605 Roberta Drive SW
Marietta GA 30008
Agency Email: Aime.Piligian@goodsamhc.org
Expiration Date: 2023-01-31
Sent to Facility: 2023-01-18
Sent to Provost: 2020-02-24
Sent to Legal:
Completed: 2020-02-26
Requester Name: Lisa Williams
Document 1: exp jan 2023 ...doc04041620200227124432
Document 2:
Document 3:
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Oasis Healthcare Service, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Troy Taylor
Phone: 470-444-1005
2195 Pace Street Suite E
Covington GA 30014
Agency Email: troytaylor@oasishealthcareservice.com
Expiration Date: 2023-05-31
Sent to Facility: 2023-08-08
Sent to Provost: 2020-06-08
Sent to Legal:
Completed: 2020-07-02
Requester Name: Lisa Williams
Document 1: ExpMay2023 OasisHealthcare_June2020 - signed
Document 2:
Document 3:
Comment: Includes Conyers, GA location
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World of Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Debbie Daugherty
Phone: 770-442-5701
3005 Royal Boulevard S Suite 110
Alpharetta GA 30022
Agency Email: ddaugherty@rayman.com
Expiration Date: 2022-10-31
Sent to Facility: 2022-10-13
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp oct 2022 ...4122339.pdf
Document 2:
Document 3:
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Cooper Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Tanji Wills
Phone: 678-473-4738
3045 Howell Ferry Road
Duluth GA 30098
Agency Email: tanji@cooperpediatrics.com
Expiration Date: 2022-12-31
Sent to Facility: 2020-01-16
Sent to Provost: 2020-01-21
Sent to Legal:
Completed: 2020-01-30
Requester Name: Lisa Williams
Document 1: exp dec 2022 ...4122518.pdf
Document 2:
Document 3:
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Emory University Student Health Services
Byrdine F Lewis School of Nursing and Health Professions
Eleanore Reiss
Phone: 404-727-7551
1525 Clifton Road
Atlanta GA 30329
Agency Email: ereis01@emory.edu
Expiration Date:
Sent to Facility: 2020-08-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/25/20 Sent again to Eleanore Reiss.
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Better Health Greater Life
Byrdine F Lewis School of Nursing and Health Professions
Alicia Lovelady
Phone: 404-999-2742
494 Boulevard SE
Atlanta GA 30312
Agency Email: Drlovelady@betterhealthgreaterlife.com
Expiration Date:
Sent to Facility: 2020-01-21
Sent to Provost: 2020-02-04
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: exp jan 2023 213164915pdf
Document 2:
Document 3:
Comment: 1/16 - contract sent. LYW
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Stay In Step Brain and Spinal Cord Injury Recovery Center
Department of Physical Therapy
Ylice Bridges
Phone: 813-977-7999
10500 University Center Dr., Suite 130
Tampa FL 33612
Agency Email: ybridges@stayinstep.org
Expiration Date: 2023-01-31
Sent to Facility: 2023-03-29
Sent to Provost: 2020-01-24
Sent to Legal:
Completed: 2020-01-30
Requester Name: Carla Huggins
Document 1: exp jan 2023 ...4122655.pdf
Document 2:
Document 3:
Comment: Received error message for following emails: Resent email 7/07/2023
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HealthPRO Heritage, LLC
Department of Occupational Therapy
Hilary Forman
Phone: 864-244-3626
536 Old Howell Road
Greenville South Carolina 29615
Agency Email: studentplacement@healthpro-heritage.com
Expiration Date:
Sent to Facility:
Sent to Provost: 2020-04-06
Sent to Legal: 2020-02-21
Completed:
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
Comment: Please also include a copy sent to
Jeanne Andreani at studentplacement@healthpro-
heritage.com
as well.
2/21/2020 sent C. Lombard word format as requested
3/17/20 to facility with Lombard redlines
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East Greenwich School District
Department of Occupational Therapy
Margaret Ucci
Phone: 401-398-1200
111 Peirce Street
East Greenwich RI 02818
Agency Email: mucci@egsd.net
Expiration Date: 2026-07-26
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-07-15
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Meadow Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Sridevi Muthukumar
Phone: 770-870-1085
10710 Medlock Bridge Road Suite 250
Johns Creek GA 30097
Agency Email: info@meadowpediatrics.com
Expiration Date: 2024-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-12
Requester Name: Lisa Williams
Document 1: Meadow Pediatrics_exp05-31-24
Document 2:
Document 3:
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U.S. Renal Care
Byrdine F Lewis School of Nursing and Health Professions
Kelly Bush
Phone: 4046685327
5851 Legacy Circle Suite 900
Plano Texas 75024
Agency Email: kbush@usrenalcare.com
Expiration Date: 2025-6-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-18
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
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Rosemont at Stone Mountain
Byrdine F Lewis School of Nursing and Health Professions
Calvonne Pittman
Phone: 770-498-4144
5160 Spring View Avenue
Stone Mountain GA 30083
Agency Email: CalvonnePittman@gmail.com
Expiration Date:
Sent to Facility: 2020-02-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Qubed Health Services LLC
Byrdine F Lewis School of Nursing and Health Professions
Heather Quaile
Phone: 678-673-3953
1275 Shiloh Road NW Suite 2030
Kennesaw GA 30144
Agency Email: drhcquaile@gmail.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-07-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Integrative Occupational Therapy Services
Department of Occupational Therapy
MaRetta Mincey
Phone: 770-577-0399
2562 Fairburn Rd Suite D-20
Douglasville GA 30135
Agency Email: Integrativeot@gmail.com
Expiration Date:
Sent to Facility: 2020-07-13
Sent to Provost: 2020-07-24
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Facility asked to change name on contract from Douglasville
Childrens Therapy Services and Associates as that is the name
of
the building, not the facility.
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University of North Georgia
Byrdine F Lewis School of Nursing and Health Professions
Elaina Butler
Phone: 706-867-2997
82 College Circel
Dahlonega GA 30597
Agency Email: elaina.butler@ung.edu
Expiration Date: 2023-01-26
Sent to Facility: 2023-08-08
Sent to Provost: 2020-01-29
Sent to Legal: 2020-01-27
Completed: 2020-03-03
Requester Name: Lisa Williams
Document 1: exp jan 2023 UNG-GSU MOU pdf
Document 2:
Document 3:
Comment: 1/27/2020 UNG is initiating this contract. Sent to
Caroline for review with copy to Kelli. LYW
1/28/2020 Caroline approved with no corrections to
Provost
for signature -Kelli
2/27/20 to facility for final signatures
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Potts Pediatrics and Adolescent Medicine
Byrdine F Lewis School of Nursing and Health Professions
Deborah Staats
Phone: 770-461-5003
365 N. Jeff Davis Drive
Fayetteville GA 30214
Agency Email: deborah@pottspediatrics.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-07
Sent to Provost:
Sent to Legal:
Completed: 2021-04-21
Requester Name: Lisa Williams
Document 1: Potts Pediatrics and Adolescent Medicine
Document 2:
Document 3:
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Rehabilitation Hospital of Southern New Mexico, Inc. dba Ernest Health/Vibra
Department of Physical Therapy
Brandon Masters
Phone: 575-521-6400
4441 E Lohman Avenue
Las Cruces NM 88011
Agency Email: brandonmasters@ernesthealth.com
Expiration Date: 2023-08-01
Sent to Facility: 2023-07-06
Sent to Provost: 2020-09-15
Sent to Legal: 2020-09-09
Completed: 2020-12-28
Requester Name: Carla Huggins
Document 1: Rehabilitation Hospital of Southern New Mexico
Document 2:
Document 3:
Comment: Site Coordinator of Clinical Education (SCCE): Molly
Staley, PTA mollystaley@ernesthealth.com
9/3/20 Facility requested changes
9/15/20 all changes accepted by both parties, to provost
for
signature
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Western Governors University
Byrdine F Lewis School of Nursing and Health Professions
Kelly Love
Phone: 385-428-5167
4001 South 700 East Suite 700
Salt Lake City UT 84107
Agency Email: kelly.love@wgu.edu
Expiration Date: Auto Renews
Sent to Facility: 2020-03-06
Sent to Provost: 2020-02-13
Sent to Legal: 2020-02-04
Completed: 2020-03-06
Requester Name: Lisa Williams
Document 1: Auto Renews WGU FULLY Executed 03.06.2020
Document 2:
Document 3:
Comment: 2/4 - to Legal for Review. LYW
3/6 provost signed. to facility for final signatures
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Clayton County Fire and Emergency Services
Byrdine F Lewis School of Nursing and Health Professions
Landry Merkison
Phone: 770-473-3831
7810 Hwy 85
Riverdale GA 30274
Agency Email: landry.merkison@ccfes.org
Expiration Date: 2023-01-31
Sent to Facility: 2020-02-14
Sent to Provost: 2020-07-02
Sent to Legal:
Completed: 2020-07-08
Requester Name: Kristen Lingle
Document 1: ExpJan2023 ClaytonCoFireEmergencySv_001
Document 2:
Document 3:
Comment: Also copy Dr. Sudha Reddy sudha.reddy@ccfes.org
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Northside Hospital Gwinnett PMHNP_Neil A. Kahn, MD
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Brooks
Phone: 678-312-3431
100 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: jennifer.brooks@northside.come
Expiration Date:
Sent to Facility: 2020-03-04
Sent to Provost: 2020-02-13
Sent to Legal: 2020-02-07
Completed:
Requester Name: Lisa Williams
Document 1: Northside Hospital Gwinnett PMHNP_Neil A. Kahn, MD
Document 2:
Document 3:
Comment: 2/6 - to Caroline for review. LYW
2/12 ok to route for signature per C. Lombard
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The University of South Alabama College of Nursing
School of Nursing
Taralyn McMullan
Phone: 770-696-2681
5721 USA Drive North
Mobile AL 36688-0002
Agency Email: tmcmullan@southalabama.edu
Expiration Date: 2018-12-07
Sent to Facility:
Sent to Provost: 2024-02-06
Sent to Legal:
Completed: 2018-09-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Sent partially exec agreement to USA 2/08/2024
3/3/20 -uploaded for record keeping purposes only. Do not
sent a renewal. LYW
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Pediatrics and Genetics
Byrdine F Lewis School of Nursing and Health Professions
Kim Lovelace
Phone: 770.346.0132
3180 North Point Parkway Suite 202
Alpharetta GA 30005
Agency Email: kim@pedgen.com
Expiration Date:
Sent to Facility: 2020-02-17
Sent to Provost: 2020-02-19
Sent to Legal:
Completed: 2020-02-25
Requester Name: Lisa Williams
Document 1: exp feb 2023 Pediatrics and Genetics.pdf
Document 2:
Document 3:
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Emory Johns Creek Hospital - OT
Department of Occupational Therapy
Komal Sahu
Phone: 404-778-4124
11670 Medlock Bridge Road
Johns Creek GA 30097
Agency Email: komal.sahu@emoryhealthcare.org
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: May be covered by general Emory contract, but submitting in
case cannot find the answer from sites.
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Fayette C.A.R.E. Clinic
Byrdine F Lewis School of Nursing and Health Professions
Barbara Conlon
Phone: (770) 719-4620
1260 Hwy 54 W. Suite 101
Fayetteville GA 30214
Agency Email: Barbara.conlon@piedmont.org
Expiration Date:
Sent to Facility: 2020-02-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Fayette C.A.R.E. Clinic
Document 2:
Document 3:
Comment: 2/12 - emailed to Patrick Washington. LYW
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My Health Reassurance
Byrdine F Lewis School of Nursing and Health Professions
Kayona Moreland
Phone: 404-480-2783
5526 Old National Highway Bldg A, Ste C
Atlanta GA 30349
Agency Email: kayonaljones@yahoo.com
Expiration Date: 2026-01-31
Sent to Facility:
Sent to Provost: 2020-03-17
Sent to Legal:
Completed: 2023-02-16
Requester Name: Lisa Williams
Document 1: My Health Reassurance
Document 2: exp jan 2023 MyHealthReassure
Document 3:
Comment: 2/12 - MOU mailed. LYW
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Physical Therapy & Rehabilitation Services, PC dba Rehab Without Walls Neuro Rehabilitation
Byrdine F Lewis School of Nursing and Health Professions
Joshua Wilt
Phone: 303-430-2490
8501 Turnpike Drive Suite 100
Westminster Colorado 80031
Agency Email: Siobhan.Nelson@rehabwithoutwalls.com
Expiration Date: 2026-08
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-12-12
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Facility returned contract on 12/10/23- Forwarded to Wanda to
be countersigned
by provost
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Evva Health
Health Informatics
Carl Hanna
Phone: 404-593-3691
3380 Peachtree RD NE Unit 1507
Atlanta Georgia 30326
Agency Email: carl@evva360.com
Expiration Date: 2023-02-28
Sent to Facility: 2020-02-24
Sent to Provost: 2020-02-27
Sent to Legal:
Completed: 2020-03-06
Requester Name: Cedric Truss
Document 1: exp feb 2023 Ellis Center Feb2020
Document 2:
Document 3:
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Peak Fitness and Physical Therapy
Department of Physical Therapy
Allison Stowers
Phone: 423-468-4067
1819 Broad Street Suite 107
Chattanooga TN 37408
Agency Email: Allison@PeakFitnessandPT.com
Expiration Date: 2023-02-28
Sent to Facility: 2023-03-14
Sent to Provost: 2020-03-04
Sent to Legal:
Completed: 2020-03-16
Requester Name: Carla Huggins
Document 1: exp feb 2023 ...6132055 pdf
Document 2:
Document 3:
Comment: Expired 2/28/2023- Renewal Submitted No response. Resent email 6/08/2023
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Chattanooga Physical Therapy
Department of Physical Therapy
Paul Iverson
Phone: 423-648-4490
1201 Market Street Suite A
Chattanooga TN 37402
Agency Email: chattanoogaphysicaltherapy@gmail.com
Expiration Date: 2026-04-30
Sent to Facility: 2020-02-25
Sent to Provost: 2020-02-28
Sent to Legal:
Completed: 2023-03-30
Requester Name: Carla Huggins
Document 1: exp feb 2023 ...6132127 pdf
Document 2:
Document 3:
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Ardeshir Rohani, MD, LTD
Byrdine F Lewis School of Nursing and Health Professions
Ardeshir Rohan
Phone: 702-463-3000
3824 S. Jones Blvd Suite A
Las Vegas NV 89103
Agency Email: Referrals4rohanimd@gmail.com
Expiration Date: 2023-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-02-26
Requester Name: Lisa Williams
Document 1: exp jan 2023 .doc04041620200227124432
Document 2:
Document 3:
Comment: 2/20 - contract sent. LYW
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High Hopes Childrens Therapy
Department of Occupational Therapy
Sarah Weirich
Phone: 6783953269
3538 Old Milton Pkwy
Alpharetta GA 30005
Agency Email: office@highhopestherapy.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Emory University-Nell Hodgson Woodruff School of Nursing
Byrdine F Lewis School of Nursing and Health Professions
Diminga Boglin
Phone: 404-778-0679
17 Executive Park Suite 650
Atlanta GA 30329
Agency Email: diminga.boglin@emory.edu
Expiration Date: 2023-07-31
Sent to Facility: 2020-04-08
Sent to Provost:
Sent to Legal: 2020-04-07
Completed: 2020-06-23
Requester Name: Lisa Williams
Document 1: ExpJul2023 EmoryNellHodgsonWoodruffSON Final
Document 2:
Document 3:
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Grady Memorial Hospital - Nutrition
Department of Nutrition
Ivan Mann
Phone: 404-616-3647
80 Jesse Hill Jr. Drive
Atlanta ga 30303
Agency Email: imannr@gmh.edu
Expiration Date: 2026-06-30
Sent to Facility: 2020-05-11
Sent to Provost:
Sent to Legal: 2020-06-29
Completed: 2023-09-11
Requester Name: jessica todd
Document 1: ExpJun2023 4654_0001 pdf
Document 2:
Document 3:
Comment: 4/29/20 Reached out to K.Taylor requesting to renew.
5/11/20 to Ivan Mann for renewal process
6/3/20 Followed up with Ivan Mann
6/29/20 I. Mann sent template. To C. Lombard for review
6/30/20 provost signed. to facility for final signature
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Encompass Health Rehabilitation Hospital of City View, Inc. - Ft Worth
Department of Occupational Therapy
Cathy Turner
Phone: 817-370-4791
6701 Oakmont Blvd
Fort Worth TX 76132
Agency Email: cathy.turner@encompasshealth.com
Expiration Date:
Sent to Facility:
Sent to Provost: 2020-03-31
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: 6-3-20 followed up with Kisha asking for update on provost
signature.
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Lucent Group
Department of Nutrition
Ashley Nelson
Phone: 404-309-5937
1420 East Linden Ave
Linden New Jersey 07036
Agency Email: kbechdol@mylucent.com
Expiration Date: 2023-02-28
Sent to Facility: 2020-03-10
Sent to Provost: 2020-04-30
Sent to Legal:
Completed: 2021-05-13
Requester Name: jessica todd
Document 1: Lucent Group_exp
Document 2:
Document 3:
Comment: clinical agreement that covers 4:
1. Roswell Nursing and Rehab
2. Woodstock Nursing and Rehab
3. Chestnut Ridge Nursing and Rehab
4. Parkside Ellijay
7/29/20 followed up with provost office
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Advent Health Medical Group
Byrdine F Lewis School of Nursing and Health Professions
Jessica Gallman
Phone: 706-879-5770
170 Curtis Parkway NE Suite 1
Calhoun GA 30701
Agency Email: jessica.gallman@adventhealth.com
Expiration Date: 2022-07-31
Sent to Facility: 2020-03-17
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Owned and operated by Adventist Health System Georgia, Inc.
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The James A. Watson Wellness Center
Byrdine F Lewis School of Nursing and Health Professions
Genine Turner
Phone: 510-444-9460
5709 Market Street
Oakland CA 94608
Agency Email: genineturner@gmail.com
Expiration Date: 2024-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-08
Requester Name: Lisa Williams
Document 1: The James A. Watson Wellness Center
Document 2:
Document 3:
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Jewish Home Life Communities
Department of Nutrition
Gracileide Gal Fonseca
Phone: 404-574-6095
3160 Howell Mill Rd. NW
Atlanta GA 30327
Agency Email: gfonseca@jewishhomelife.org
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-03
Requester Name: Jessica Johnson
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
Jewish Home Life Communities
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The Wellness Den by Cynergy Physical Therapy
Department of Physical Therapy
Chivonne Henriques
Phone: 212-292-7117
177 East 87th Street
New York NY 10128
Agency Email: chivonne@cynergypt.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please email ptclinicaleducation@gsu.edu as well.
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Savannah Health Services, LLC d/b/a Memorial Health University Medical Center
Department of Physical Therapy
Pam Edwards
Phone: 912-350-7268
4700 Waters Avenue
Savannah GA 31404
Agency Email: mmcs.student@hcahealthcare.com
Expiration Date: 2022-04-30
Sent to Facility: 2023-06-06
Sent to Provost: 2020-05-08
Sent to Legal: 2020-04-02
Completed: 2020-08-14
Requester Name: Carla Huggins
Document 1: ExpMay2022 Savannah Health Services
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
HCA South Atlantic DIV
send edits from review originally initiated in 2022. Left voicemail message 6/06/23
Did not receive response 3/15/2023
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Academics Plus
Department of Occupational Therapy
Katie Cyphers
Phone: (706) 402-1720
3401 Northside Pkwy NW Suite 240
Atlanta GA 30327
Agency Email: katie@aplusatl.com
Expiration Date:
Sent to Facility: 2020-03-25
Sent to Provost: 2020-03-31
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Please also include Carolyn Podolski in the email when you
send the contract, as she would like to use this site for
future Level 1 placements: cpodolski@gsu.edu. Thanks!
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ERW Physical Therapy
Department of Physical Therapy
Caitlyn Creswell
Phone: (706)-868-1707
415 Town Park Blvd
Evans GA 30809
Agency Email:
Expiration Date: 2026-4-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-02
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please email ptclinicaleducation@gsu.edu
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DMA Services inc, DBA Visiting Angels
Department of Occupational Therapy
Gary Stiefel
Phone: 404-991-4218
117750 Northfall Ln 207
Alpharetta Georgia 30009
Agency Email: gstiefel@visitingangels.com
Expiration Date:
Sent to Facility: 2023-04-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda!
This is my first request for a clinical agreement for
Capstone. The contract should be the one we use for
community-based sites, not hospitals. Please contact me if
you have any questions about this.
Thanks,
Carolyn Podolski
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Milestone Pediatrics
Department of Physical Therapy
Iyabo Okuwobi
Phone: 770-414-0337
1438 McLendon Drive
Decatur GA 30033
Agency Email: iyabo@driyabo.com
Expiration Date: 2023-04-30
Sent to Facility: 2023-03-21
Sent to Provost: 2020-05-12
Sent to Legal:
Completed: 2020-06-03
Requester Name: Carla Huggins
Document 1: exp april 2023 MilestonePeds for Provost - signed pdf
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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Emory University School of Medicine
Byrdine F Lewis School of Nursing and Health Professions
Deidre Tindal
Phone: 404-778-7548
100 Woodruff Circle NE
Atlanta GA 30322
Agency Email: deidre.tindal@emoryhealthcare.org
Expiration Date: 2025-06-30
Sent to Facility: 2020-08-10
Sent to Provost: 2020-07-06
Sent to Legal: 2020-06-16
Completed: 2022-05-22
Requester Name: Lisa Williams
Document 1: Emory School of Medicine
Document 2:
Document 3:
Comment: 8/4/20 MOU amended to include all Lewis College routed to
provost for signature
8/10/20 to facility for final signatures
final MOU uploaded 02-02-21
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BWell Medical and Wellness Center
Roland Atta-Ampiah
Phone: 678-742-8649
5933 Stewart Parkway
Douglasvlle GA 30135
Agency Email: info@bwellmedicalwellness.com
Expiration Date: 2026-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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South Fulton Emergency Physicians, LLC
School of Nursing
Nina Nguyen
Phone: (404)961-6548
5665 New Northside Drive Suite 200
Atlanta GA 30328
Agency Email: nnguyen@apollomd.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Dr. Angela Dawson
Byrdine F Lewis School of Nursing and Health Professions
Angela Dawson
Phone: 229-312-7000
306 Shorter Avenue
Rome GA 30165
Agency Email: Adawson@floyd.org
Expiration Date:
Sent to Facility: 2020-06-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: August 2020 marked inactive, preceptor is not available
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Byron Family Healthcare Center
Byrdine F Lewis School of Nursing and Health Professions
Gina Kirk
Phone: 478-956-2648
200 Highway GA 49
Byron GA 31008
Agency Email: gina@byronfamilyhealthcare.com
Expiration Date: 2026-06-30
Sent to Facility: 2020-07-13
Sent to Provost: 2020-07-14
Sent to Legal:
Completed: 2023-09-27
Requester Name: Lisa Williams
Document 1: ExpJun2023 ByronFamily forProvost signed
Document 2:
Document 3:
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Palmetto Health Council dba YourTown Health
Byrdine F Lewis School of Nursing and Health Professions
Luke Putnam
Phone: 770-626-4029
643 Main Street
Palmetto GA 30268
Agency Email: l.putnam@yourtownhealth.com
Expiration Date:
Sent to Facility: 2020-08-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/25/20 This site is not taking students at this time.
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Faebris Medical and Community Education
Byrdine F Lewis School of Nursing and Health Professions
Karen Crews-Brown
Phone: 404-390-3647
285 Boulevard NE
Atlanta GA 30312
Agency Email: kcrewsbrown@faebris.com
Expiration Date:
Sent to Facility: 2020-07-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 8/14/20 Facility is not accepting students at this time
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The East Alabama Health Care Authority
Department of Physical Therapy
Laura Grill
Phone: 334-528-3271
2000 Pepperrell Parkway
Opelika AL 36801
Agency Email: tony.sumner@eamc.org
Expiration Date: 2023-07-31
Sent to Facility: 2023-06-06
Sent to Provost: 2020-09-16
Sent to Legal: 2020-08-18
Completed: 2020-09-17
Requester Name: Carla Huggins
Document 1: Eastside Medical and GSU PT Contract
Document 2:
Document 3:
Comment: No Response. Resent request to facility 6/06/23
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UGA Cooperative Extension - Fulton County
Department of Nutrition
Laurie Murrah-Hanson
Phone: 404-814-4099
130 West Paces Ferry Road, NW
atlanta ga 30305
Agency Email: laurs@uga.edu
Expiration Date:
Sent to Facility: 2020-08-11
Sent to Provost: 2020-09-02
Sent to Legal:
Completed: 2020-09-11
Requester Name: jessica todd
Document 1: view
Document 2:
Document 3:
Comment: Non Clinical
8/11/20 Dr. Murrah-Hanson requested name on agreement be
changed
to Board of Regents of the University System of Georgia
by and
on behalf of the University of Georgia Cooperative
Extension
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Atlanta Diabetes Associates
Department of Nutrition
Caroline Williams
Phone: 404-355-4393
1800 Howell Mill Rd Suite 450
Atlanta GA 30318
Agency Email: cwilliams@atlantadiabetes.com
Expiration Date: 2026-07-31
Sent to Facility: 2023-06-30
Sent to Provost:
Sent to Legal:
Completed: 2024-01-11
Requester Name: Jessica Todd
Document 1: view
Document 2:
Document 3:
Comment: Clinical
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Clinica Union Medical Centers
Byrdine F Lewis School of Nursing and Health Professions
Melissa Salicado
Phone: 404-321-4692
3369 Buford Hwy Suite 810
Atlanta GA 30329
Agency Email: msalcido@unionhcn.com
Expiration Date:
Sent to Facility: 2020-08-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/1/20 Clinic is not accepting students at this time. marking in
active
|
| |
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Divine Healthcare Services
Byrdine F Lewis School of Nursing and Health Professions
Jerwanda Johnson
Phone: 678-829-3812
11764 Hastings Bridge Road
Hampton GA 30228
Agency Email: Divine.jmedcare@gmail.com
Expiration Date: 2023-07-31
Sent to Facility: 2023-06-13
Sent to Provost: 2020-08-14
Sent to Legal:
Completed: 2020-08-20
Requester Name: Lisa Williams
Document 1: ExpJul2023 DivineHC Svcs Aug20
Document 2:
Document 3:
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Jasper Memorial Hospital
Department of Physical Therapy
Marlena Waddell
Phone: 706-468-4554
898 College St.
Monticello GA 31064
Agency Email: mwaddell@jaspermemorial.com
Expiration Date: 2023-08-31
Sent to Facility: 2023-03-27
Sent to Provost: 2020-09-15
Sent to Legal:
Completed: 2020-10-21
Requester Name: Carla Huggins
Document 1: view
Document 2:
Document 3:
Comment: Updated email to Marlena Waddell
mwaddell@jaspermemorial.com
Expires 8/31/2023- Renewal Submitted--- No Response. Resent request to facility 6/06/23
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Atlanta Dermatology & Laser Surgery
Byrdine F Lewis School of Nursing and Health Professions
Rhonda Howard
Phone: 404-296-8000
1462 Montreal Road Suite 411
Tucker GA 30084
Agency Email: rhoward@atlderm.com
Expiration Date:
Sent to Facility: 2020-08-12
Sent to Provost: 2020-09-01
Sent to Legal:
Completed: 2020-09-11
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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| |
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TD Wellness
David Orozco
Phone: (770)853-0851
P.O. Box 795
Decatur GA 30031
Agency Email: info@orozconutrition.com
Expiration Date:
Sent to Facility: 2023-06-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
Comment: non-clinical
|
| |
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|
Northeast Georgia Gynecology at Luminous Med Spa and Gynaesthetics
Byrdine F Lewis School of Nursing and Health Professions
Helen Klassen
Phone: 770-532-9250
440 Washington Street
Gainesville GA 30501
Agency Email: Helen@negagyn.com
Expiration Date: 2023-10-31
Sent to Facility: 2020-08-25
Sent to Provost:
Sent to Legal:
Completed: 2020-10-16
Requester Name: Lisa Williams
Document 1: Northeast Georgia Gynecology at Luminous Med Spa and Gynaesthetic
Document 2:
Document 3:
Comment: send signed MOU to Legal Affairs 10-14-20
|
| |
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Stat Wellness
Department of Nutrition
Sarah Ganka
Phone: 4042545905
1465 Howell Mill Rd Unit 300A
Atlanta ga 30318
Agency Email: sarahrose@statwellness.com
Expiration Date: 2025-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-04-29
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical MOU please send to admin listed - to cover Atlanta
and Roswell Locations
|
| |
|
|
Khair Family Practice
Byrdine F Lewis School of Nursing and Health Professions
Christen Cochran
Phone: 770-213-3366
125 Eagle Spring Drive
Stockbridge GA 30281
Agency Email: ccochran@khairfp.com
Expiration Date:
Sent to Facility: 2020-09-01
Sent to Provost: 2020-09-03
Sent to Legal:
Completed: 2020-09-11
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
Comment: cchochran@khairfp.com undeliverable
9/1 - resent to correct e-mail address -
ccochran@khairfp.com. lyw
|
| |
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E.P.Y.S Empower YourSelf Behavioral Health Services, LLC
Byrdine F Lewis School of Nursing and Health Professions
Damion Brooks, Sr
Phone: 478- 273- 1086
108 Olympia Drive Suite 104D
Warner Robins GA 31093
Agency Email: info@epysbehavioralhealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
|
| |
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|
Sulton Pediatric Group
Byrdine F Lewis School of Nursing and Health Professions
Jacqueline Sulton
Phone: 770-670-6100
2258 Northlake Pkwy Suite 100
Tucker GA 30084
Agency Email: DrSulton@sultonpeds.com
Expiration Date: 2026-08-31
Sent to Facility: 2020-09-03
Sent to Provost: 2020-09-08
Sent to Legal:
Completed: 2023-09-12
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
|
| |
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|
DeKalb Pediatric Group
Byrdine F Lewis School of Nursing and Health Professions
Denise Manigault
Phone: 404-296-7133
3065 S. Cobb Drive SE
Smyrna GA 30080
Agency Email: denisepnp@aol.com
Expiration Date:
Sent to Facility: 2020-09-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
|
| |
|
|
Heartland Equine Therapeutic Riding Academy (HETRA)
Department of Occupational Therapy
Kaiti King
Phone: 402-359-8830
10130 S 222nd Street
Gretna NE 68028
Agency Email: kking@hetra.org
Expiration Date: 2023-10-31
Sent to Facility: 2020-09-08
Sent to Provost:
Sent to Legal:
Completed: 2020-10-28
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
|
| |
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|
Spectrum Pediatric Group
Byrdine F Lewis School of Nursing and Health Professions
Kola Ologunja
Phone: 770-966-0778
3150 Cobb Parkway Suite 130
Kennesaw GA 30152
Agency Email: info@spectrumpeds.com
Expiration Date: 2023-09-14
Sent to Facility: 2020-09-09
Sent to Provost: 2020-09-22
Sent to Legal:
Completed: 2020-11-23
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
|
| |
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|
Peach Pediatric
Byrdine F Lewis School of Nursing and Health Professions
Amy Zimmerman
Phone: 404-591-1426
3280 Howell Mill Road Suite 309
Atlanta GA 30327
Agency Email: azimmerman@entofga.com
Expiration Date: 2023-09-14
Sent to Facility: 2024-03-12
Sent to Provost: 2020-09-09
Sent to Legal:
Completed: 2020-09-11
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
|
| |
|
|
Encompass Health Rehabilitation Hospital of Albuquerque
Department of Occupational Therapy
Kristen Hernandez
Phone: 505-563-4035
7000 Jefferson St. NE
Albuquerque NM 87109
Agency Email: Kristen.hernandez@encompasshealth.com
Expiration Date: 2023-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-02-25
Requester Name: Shana Finks
Document 1: Encompass Albuquerque
Document 2:
Document 3:
|
| |
|
|
Center For Pediatric Therapy
Department of Occupational Therapy
Kari Eckberg
Phone: 509-487-2958
6710 N Country Homes Blvd
Spokane WA 99228
Agency Email: Kari.Eckberg@spokanecpt.com
Expiration Date: 2027-02-28
Sent to Facility: 2020-09-16
Sent to Provost: 2024-03-01
Sent to Legal:
Completed: 2024-03-06
Requester Name: Karen McWaters
Document 1: Center for Pediatric Therapy Jan 2021
Document 2:
Document 3:
Comment: For spring 2021 placement
|
| |
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|
Premier Family Clinic
Byrdine F Lewis School of Nursing and Health Professions
Nipun Patel
Phone: 770-493-6767
3646 Chamblee Tucker Road Suite B
Atlanta GA 30341
Agency Email: Rutvaprutha@yahoo.com
Expiration Date: 2026-08-31
Sent to Facility: 2020-09-16
Sent to Provost: 2020-09-22
Sent to Legal:
Completed: 2023-12-01
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
|
| |
|
|
Imagine Pediatrics, PC
Byrdine F Lewis School of Nursing and Health Professions
Erica Paez
Phone: 706-528-4949
18 Riverbend Drive SW Suite 210
Rome GA 30161
Agency Email: ericapaez18@gmail.com
Expiration Date:
Sent to Facility: 2020-09-22
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
|
| |
|
|
Help for Healthcare Professionals, Inc.
Health Informatics
Shelli McKenzie
Phone: 678-948-5173
1971 Birch Crest Place
Dacula Georgia 30019
Agency Email: info@hhcpinc.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
|
| |
|
|
Kids Creek Therapy
Department of Occupational Therapy
Melanie McGriff
Phone: 770-888-5221
4055 Johns Creek Parkway Suite A
Suwanee GA 30024
Agency Email: info@kidscreektherapy.com
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost: 2024-01-16
Sent to Legal:
Completed: 2024-01-19
Requester Name: Karen McWaters
Document 1: Kids Creek Therapy Jan 2021
Document 2:
Document 3:
Comment: Sent MOU to facility on 12/12/23
|
| |
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|
Mindset Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Omolola Otubaga
Phone: 470-646-3738
135 Bradford Square Suite B
Fayetteville GA 30215
Agency Email: info@mindsethealthcare.com
Expiration Date: 2023-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Mindset Healthcare_02-01-2021
Document 2:
Document 3:
|
| |
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|
Tangu Inc.
Byrdine F Lewis School of Nursing and Health Professions
Walter Brooks
Phone: 404-220-7362
1820 Water Place Suite 250
Atlanta GA 30339
Agency Email: Drwalterbrooks1820@hotmail.com
Expiration Date: 2023-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Tangu Inc_02-01-2021
Document 2:
Document 3:
Comment: 10/12/20 - sent contract. LYW
|
| |
|
|
Hopebridge, LLC
Department of Occupational Therapy
Kim Strunk
Phone: 317.794.3230
3500 DePauw Blvd Suite 3060
Indianapolis IN 46268
Agency Email: bteusch@hopebridge.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-16
Requester Name: Shana Finks
Document 1: Hopebridge_exp11-30-2023
Document 2:
Document 3:
|
| |
|
|
Aspire Pediatric Therapy of Georgia
Department of Occupational Therapy
Heather Cox
Phone: (770) 965-1861
7367 SPOUT SPRINGS RD SUITE 125
Flowery Branch GA 30542
Agency Email: hcox@aspiretherapy.org
Expiration Date: 2026-12-31
Sent to Facility: 12/12/23
Sent to Provost:
Sent to Legal:
Completed: 2024-02-08
Requester Name: Karen McWaters
Document 1: view
Document 2:
Document 3:
Comment: Sent MOU to facility on 12/12/23
|
| |
|
|
Centro International de Maternidad
Byrdine F Lewis School of Nursing and Health Professions
Maria Francis
Phone: 770-451-3100
2000 Clearview Avenue Suite 111
Doraville GA 30340
Agency Email: mfrancis@cimasalud.net
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: CIMA MOU final
Document 2:
Document 3:
Comment: locations in Doraville and Norcross.
10/28-contract sent by LYW
|
| |
|
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Cox Corporate Services Inc
Department of Nutrition
Mary Groover
Phone: 6786452788
6205 - A Peachtree Dunwoody Rd
Atlanta GA 30328
Agency Email: mary.groover@coxinc.com
Expiration Date: 2026-10-31
Sent to Facility:
Sent to Provost: 2024-01-02
Sent to Legal:
Completed: 2024-01-11
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: This is a non-clinical agreement
|
| |
|
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Village Pathways Therapy
Department of Occupational Therapy
Dionne Brunson
Phone: (404) 289-4270
2385 Lawrenceville Hwy B
Decatur GA 30033
Agency Email: frontofficevillpath@gmail.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-11
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
|
| |
|
|
Willing Helpers Medical, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Belinda Herndon
Phone: 678-625-8317
P.O. Box 2508
Covington GA 30015
Agency Email: info@willinghelpersclinic.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-11-20
Requester Name: Charlette DeLoach
Document 1: view
Document 2:
Document 3:
|
| |
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|
Georgia CTSA Clinical Research Centers
Department of Nutrition
Kristen Narlow
Phone: 4047788570
.
Atlanta Ga .
Agency Email: kristen.narlow@emory.edu
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-03-30
Requester Name: jessica Todd
Document 1: Georgia CTSA Clinical Research Centers
Document 2:
Document 3:
|
| |
|
|
Kennestone Internal Medicine Associates
Byrdine F Lewis School of Nursing and Health Professions
Renae Forrester
Phone: 770-419-7074
790 Church Street Suite 325
Marietta GA 30060
Agency Email: R_Forrester@bellsouth.net
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Kennestone Internal Medicine Associates
Document 2:
Document 3:
|
| |
|
|
Health1Care Medical Group
Byrdine F Lewis School of Nursing and Health Professions
Heidi Joung
Phone: 770-497-4188
10710 Medlock Bridge Road Suite 150
Johns Creek GA 30097
Agency Email: heidijoung@yahoo.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-03
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
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| |
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|
John Lee MD OBGYN
Byrdine F Lewis School of Nursing and Health Professions
John Lee
Phone: 678-753-7084
4310 Johns Creek Parkway Suite 180
Suwanee GA 30024
Agency Email: manager@johnleeobgyn.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-04
Requester Name: Lisa Williams
Document 1: view
Document 2:
Document 3:
|
| |
|
|
Coastal Pediatric Therapy Center
Department of Occupational Therapy
Kellie Wright
Phone: (904)372-4070
2730 Isabella Blvd Suite 10.
Jacksonville Beach FL 32250
Agency Email: kellie@coastaltherapy.net
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-04
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
Comment: The other location to be included in the contract is 6100
Greenland Road Suite 204
Jacksonville FL 32258. Thanks!
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| |
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Centura Health
Byrdine F Lewis School of Nursing and Health Professions
Angela Shopp
Phone: 303.673.8225
9100 E. Mineral Circle
Centennial CO 80112
Agency Email: angelashopp@centura.org
Expiration Date: 2023-12-2
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2020-12-15
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
|
| |
|
|
Centre for Neuro Skills
Tammy Harper
Phone: 972-580-8500
4851 Regent Boulevard Suit 200
Irving TX 75063
Agency Email: tharper@neuroskills.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-20
Requester Name: Shana Finks
Document 1: view
Document 2:
Document 3:
|
| |
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Valley Pediatric & Specialty Center
Byrdine F Lewis School of Nursing and Health Professions
Teresita Melocoton
Phone: 702-388-4428
3701 W. Charleston Boulevard
Las Vegas GA 89102
Agency Email: Doc159747@yahoo.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 21-03-10
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
|
| |
|
|
Centro Prenatal de Georgia
Byrdine F Lewis School of Nursing and Health Professions
Maria Miranda
Phone: 470-514-5818
5195 Jimmy Carter Boulevard P.O. Box 937
Norcross GA 30093
Agency Email: mirandacpdg@gmail.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Centro Prenatal de Georgia_2-01-21
Document 2:
Document 3:
|
| |
|
|
Colorblind, Inc
Department of Occupational Therapy
Ray Lora
Phone: (404) 947-1818
245 N. Highland Ave NE Suite 230-384
Atlanta GA 30307
Agency Email: colorblindinc07@gmail.com
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 21-01-25
Requester Name: Shana Finks
Document 1: Colorblind Inc Jan 2021
Document 2:
Document 3:
|
| |
|
|
Albany State University
Byrdine F Lewis School of Nursing and Health Professions
Sherry Koster
Phone: 229-500-2336
504 College Drive
Albany GA 31705
Agency Email: skoster@asurams.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Albany State University
Document 2:
Document 3:
Comment: 12/4/2020 - requested contract template. LYW
|
| |
|
|
Health and Kindness LLC
Department of Nutrition
Rachel West
Phone: 601-754-2075
1459 Oxford Rd NE 301
Atlanta GA 30307
Agency Email: rachelowest@gmail.com
Expiration Date: 2023-11-30
Sent to Facility: 2023-10-17
Sent to Provost:
Sent to Legal:
Completed: 2021-01-25
Requester Name: Jessica Todd
Document 1: Health and Kindness LLC Jan 2021
Document 2:
Document 3:
Comment: clinical contract
|
| |
|
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Albany State University
Byrdine F Lewis School of Nursing and Health Professions
Robbin Burriss
Phone: 229.500.3022
2400 Gillionville Road
Albany GA 31707
Agency Email: robbin.burriss@asurams.edu
Expiration Date: 2023-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 21-03-10
Requester Name: Lisa Williams
Document 1: Albany State University
Document 2:
Document 3:
|
| |
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|
Premise Health
Byrdine F Lewis School of Nursing and Health Professions
Michele Crawford
Phone: 404-785-2185
1575 Northeast Expressway
Atlanta GA 30329
Agency Email: michele.crawford@premisehealth.com
Expiration Date: 2024-01-31
Sent to Facility: 2024-01-18
Sent to Provost:
Sent to Legal:
Completed: 2021-03-10
Requester Name: Lisa Williams
Document 1: Premise Health
Document 2:
Document 3:
|
| |
|
|
Vanderbilt Stallworth Rehabilitation Hospital
Department of Occupational Therapy
James Harness
Phone: 615-320-7600
2201 Childrens Way
Nashville TN 37212
Agency Email: james.harness@encompasshealth.com
Expiration Date: 2024-04-19
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-21
Requester Name: Karen McWaters
Document 1: Vanderbilt Stallworth Rehabilitation Hospital_exp_4-19-24
Document 2:
Document 3:
|
| |
|
|
DH Therapy LLC
Department of Occupational Therapy
Damir Hecimovic
Phone: 404-901-6807
7 Dunwoody Park Suite 104
Atlanta GA 30338
Agency Email: dhtherapy@icloud.com
Expiration Date: 2024-07-31
Sent to Facility: 2024-04-10
Sent to Provost:
Sent to Legal:
Completed: 2021-08-24
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment:
ekabu@dhtherapyatlanta.com new contact person 4-10-24
Address updated to
7 Dunwoody Park,
Suite 104
Atlanta, GA 30338
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Ethne Health
Byrdine F Lewis School of Nursing and Health Professions
Esther Kim
Phone: 470-799-0044
4122 E Ponce de Leon Ave Suite 5
Clarkston GA 30021
Agency Email: esther.kim@ethnehealth.org
Expiration Date: 2024-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-25
Requester Name: Lisa Williams
Document 1: Ethne Health Jan 2021
Document 2:
Document 3:
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Atlanta Psychiatry and Addiction
Byrdine F Lewis School of Nursing and Health Professions
Stephen Dudley
Phone: 404-901-8142
2150 Peachford Road Suite 1
Dunwoody GA 30338
Agency Email: atlantapsychiatryandaddiction@gmail.com
Expiration Date: 2024-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Atlanta Psychiatry and Addiction_2-01-21
Document 2:
Document 3:
Comment: 1/22 - contract delivered to practice by student. LYW
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Ideal Gynecology
Byrdine F Lewis School of Nursing and Health Professions
Kathryn Garren
Phone: 404-334-9103
3200 Downwood Circle NW Suite 220
Atlanta Georgia 30327
Agency Email: kgarren@idealgynecology.com
Expiration Date: 2024-01-31
Sent to Facility: 2024-01-18
Sent to Provost:
Sent to Legal:
Completed: 2021-01-28
Requester Name: Lisa Williams
Document 1: Ideal Gynecology
Document 2:
Document 3:
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Prime Health Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Bunmi Folarinde
Phone: 678-288-9740
3616 S. Bogan Road Suite 202
Buford GA 30519
Agency Email: info@primehealthsystem.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-09
Sent to Provost:
Sent to Legal:
Completed: 2021-03-18
Requester Name: Lisa Williams
Document 1: Prime Health Medical Center
Document 2:
Document 3:
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GloFusion Urgent and Primary Care
Byrdine F Lewis School of Nursing and Health Professions
Judith Ngulefac
Phone: 678-603-2898
1705 Williamson Road Suite 101
Griffin GA 30224
Agency Email: info@glofusionhealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Emory Hospital: Comprehensive Weight Loss Center
Department of Nutrition
Brittany Jones
Phone: 4045017818
2665 N Decatur Rd 150
decatur GA 30030
Agency Email: brittany.jones@emoryhealthcare.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: We have had a contract with Emory bariatrics in the past but
it is expired.
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Childrens Medicine, P.C.
Byrdine F Lewis School of Nursing and Health Professions
Trudy Hunley
Phone: 770-921-7386
3685 Lawrenceville Highway Suite 100
Lawrenceville GA 30044
Agency Email: trudy.hunley@childrensmedicine.net
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Childrens Medicine PC
Document 2:
Document 3:
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Beautiful Minds Mental Health Services
Byrdine F Lewis School of Nursing and Health Professions
Shakeitha Colvard
Phone: 678-269-7865
3200 Highlands Parkway Suite 400
Smyrna GA 30082
Agency Email: scolvard@mymindsbeauty.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-07
Sent to Provost: 2024-03-26
Sent to Legal:
Completed: 2021-03-17
Requester Name: Lisa Williams
Document 1: Beautiful Minds Mental Health Services
Document 2:
Document 3:
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Truths Community Clinic
Byrdine F Lewis School of Nursing and Health Professions
Mamie Outler
Phone: 770-277-4675
250 Langley Drive Suite 1315
Lawrenceville GA 30046
Agency Email: info@truthsclinic.org
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Truths Community Clinic
Document 2:
Document 3:
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JS Therapies
Department of Occupational Therapy
Julie Sommer
Phone: (340) 277-4995
5030 Anchor Way Suite 6
St. Croix Christiansted 00820
Agency Email: juliewsommer@yahoo.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Middle Georgia Family Rehab
Department of Occupational Therapy
Brenda Hicks
Phone: (478) 956-4916
P.O. Box 1552
Byron GA 31008
Agency Email: taylorbrenda74@yahoo.com
Expiration Date: 2024-06-30
Sent to Facility: 2024-04-10
Sent to Provost: 2024-04-11
Sent to Legal:
Completed: 09/02/2021
Requester Name: Karen McWaters
Document 1: Middle Georgia Family Rehab
Document 2:
Document 3:
Comment: Contract is for clinical placement that will start in Jan.
2022 - Please set up contract to auto-renew if possible.
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Gwinnett County Board of Health
Byrdine F Lewis School of Nursing and Health Professions
Connie Russell
Phone: 770-339-4260
2570 Riverside Pkwy
Lawrenceville GA 30046-0897
Agency Email: info@gnrhealth.com
Expiration Date: 2025-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-21
Requester Name: Anne Cadet
Document 1: Gwinnett County Board of Health
Document 2:
Document 3:
Comment: alana.sulka@gnrhealth.com 4/5/22 - requesting renewal
The number below was also listed as a contact -
B. June Brown, CIO
P | 770.339.4260
F | 770.339.2334
Beverly June Brown
Chief Information Officer
Audrey Arona, M.D
District Health Director, CEO
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Northeast Atlanta Ear Nose & Throat, PC
Byrdine F Lewis School of Nursing and Health Professions
Mary Budrock
Phone: 770-237-3000
766 Walther Road Suite 300
Lawrenceville GA 30046
Agency Email: mbudrock@myents.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-07
Sent to Provost:
Sent to Legal:
Completed: 2021-04-30
Requester Name: Lisa Williams
Document 1: Northeast Atlanta Ear Nose & Throat, PC_exp_02-29-2024
Document 2:
Document 3:
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North Texas Therapy Innovations
Department of Occupational Therapy
Elizabeth McBride
Phone: 214-349-6178
11886 Greenville Ave Suite 110
Dallas TX 75243
Agency Email: northtexastherapyinnovations@outlook.com
Expiration Date: 2024-02-29
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-03-17
Requester Name: Shana Finks
Document 1: North Texas Therapy Innovations
Document 2:
Document 3:
Comment: If possible, please expedite. The student will begin Level
2 fieldwork on April 19th 2021. -Letitia Carelock
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OMS Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Ashley Carter
Phone: 770-672-6267
2145 Roswell Road Suite 60
Marietta GA 30062
Agency Email: PM1@oms-urgentcare.com
Expiration Date: 2024-02-29
Sent to Facility: 2024-02-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: OMS Urgent Care
Document 2:
Document 3:
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Atlanta VA Healthcare System
Health Informatics
Archie Brown
Phone: 404-321-6111 ext. 123784
1670 Clairmont Road
Decatur Georgia 30033
Agency Email: Archie.Brown@va.gov
Expiration Date: 2032-02-01
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-25
Requester Name: Cedric Truss
Document 1:
Document 2:
Document 3:
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Augusta University Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Wyatt Mobley
Phone: 706.721.3771
1120 15th Street BA4230
Augusta GA 30319
Agency Email: wymobley@augusta.edu
Expiration Date: 2024-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Augusta University Medical Center
Document 2: Augusta University Medical Center - Nursing
Document 3:
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Fyzical Therapy and Balance Centers
Byrdine F Lewis School of Nursing and Health Professions
Erin Brandl
Phone: 402-330-3211
4614 S. 132nd St.
Omaha Nebraska 68137
Agency Email: ebrandl@fyzicalnebraska.com>
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2025-12-08
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Owner of Business:
Owner/President: Michael Bryant, PT, DPT, OCS
4614 S. 132nd St.
Omaha, NE 68137
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Ohio State University Health System, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Ambulatory Services
Department of Physical Therapy
Tiffany Marulli
Phone: 614-293-2385
2835 Fred Taylor Drive
Columbus OH 43202-1552
Agency Email: Tiffany.Marulli@osumc.edu
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-06-02
Requester Name: Carla Huggins
Document 1: Ohio State University_auto_renewal
Document 2: Ohio State University_autorenewal
Document 3:
Comment: auto renewal
Partially executed sent to site 03/30/21
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Harmony Nutrition LLC
Department of Nutrition
Abby Johnson
Phone: 4044478057
1802 Abbey Ct
alpharetta ga 30004
Agency Email: abby@harmonynutritionatl.com
Expiration Date: 2024-03-31
Sent to Facility: 2024-03-20
Sent to Provost:
Sent to Legal:
Completed: 2021-03-29
Requester Name: Jessica Todd
Document 1: Harmony Nutrition LLC
Document 2:
Document 3:
Comment: Nonclinical
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MAJL Diagnostic Laboratories
Byrdine F Lewis School of Nursing and Health Professions
Lisa Cloud
Phone: 877-272-5008
6290 McDonough Drive Suite D
Norcross GA 30093
Agency Email: lisa@majldiagnostics.com
Expiration Date: 2024-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-03-29
Requester Name: Lisa Williams
Document 1: MAJL Diagnostic Laboratories
Document 2:
Document 3:
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Elite Medical Associates
Byrdine F Lewis School of Nursing and Health Professions
Lisa Cloud
Phone: 877-272-5008
6290 McDonough Drive Suite D
Norcross GA 30093
Agency Email: lisa@majldiagnostics.com
Expiration Date:
Sent to Facility: 2021-03-25
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Baptist Healthcare System Inc
Department of Physical Therapy
Lee Ann Morse
Phone: (270)575-2806
2701 Eastpoint Parkway
Lousiville Kentucky 40223
Agency Email: lee.morse@BHSI.COM
Expiration Date: 2022-07-01
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-03-11
Requester Name: Carla Huggins
Document 1: Baptist Healthcare System Inc
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Sunrise Senior Living
Byrdine F Lewis School of Nursing and Health Professions
Terrell Brown
Phone: 703-659-7024
7902 Westpark Drive
McLean VA 22102
Agency Email: terrell.brown@sunriseseniorliving.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet-Baker
Document 1:
Document 2:
Document 3:
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Northside Hospital Gwinnett
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Brooks
Phone: 678-312-3431
100 Medical Center Boulevard 115
Lawrenceville GA 30046
Agency Email: Jbrooks@gwinnettmedicalcenter.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet-Baker
Document 1: Northside Hospital _Gwinnett Health System_exp_3-18-2024
Document 2: Northside Gwinnett Health System
Document 3:
Comment: Northside Hospital, Inc. has acquired Gwinnett Health
System, Inc and the renewal should reflect the new name.
Please include Charlette DeLoach in all communications
cdeloach@gsu.edu.
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Northside Hospital Duluth
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Brooks
Phone: (678) 312-3431
100 Medical Center Boulevard 115
Lawrenceville GA 30046
Agency Email: Jbrooks@gwinnettmedicalcenter.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: Northside Hospital, Inc. has acquired Gwinnett Health
System, Inc. The Duluth location was part of that chain,
but it seems to be a stand alone entity of Northside now.
The renewal should reflect the new name. Please include
cdeloach@gsu.edu in all communications.
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Sunshine Home Health Care
Byrdine F Lewis School of Nursing and Health Professions
Gretchen Anderson
Phone: 509-321-9050
10410 E 9th
Spokane Valley Washington 99206
Agency Email: gretchena@shfi.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1: Sunshine Home Health Care
Document 2:
Document 3:
Comment: This request is for a placement that will need to begin no later than May 10th. The
student is scheduled to begin this rotation on April 26th. This late request is due to
difficulties with locating sites during the pandemic at an out of state location.
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Craig Wellness & Recovery
Byrdine F Lewis School of Nursing and Health Professions
James Craig
Phone: 770-720-5011
2205 Riverstone Blvd. Suite 205
Canton GA 30114
Agency Email: jamesccraig4@msn.com
Expiration Date: 2024-04-30
Sent to Facility: 2024-04-11
Sent to Provost:
Sent to Legal:
Completed: 2021-04-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Playworks Pediatric Therapy Services
Department of Occupational Therapy
Sandy Buttine
Phone: 972.387.1100
12880 Hillcrest Rd #102
Dallas Texas 75230
Agency Email: sandy.buttine@playworkspts.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1: Playworks Pediatric Therapy Services-exp_04-30-21
Document 2:
Document 3:
Comment: Time Sensitive: Standard Contract Student begins on May 10th. Reason:
Pandemic- contacted over 45 sites - only one in Dallas area to take our student
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Bortolazzo Group, LLC
Byrdine F Lewis School of Nursing and Health Professions
Nina Nguyen
Phone: 404-961-6548
5665 New Northside Drive Suite 200
Atlanta GA 30328
Agency Email: nnguyen@apollomd.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Cobb, Douglas and Paulding locations
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Bortolazzo Group LLC
Byrdine F Lewis School of Nursing and Health Professions
Nina Nguyen
Phone: 404-961-6548
5665 New Northside Drive Suite 200
Atlanta GA 30328
Agency Email: nnguyen@apollomd.com
Expiration Date: 2025-04-20
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-04-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Cobb, Douglas and Paulding locations
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Bortolazzo Group LLC
Byrdine F Lewis School of Nursing and Health Professions
Nina Nguyen
Phone: 404-961-6548
5665 New Northside Drive Suite 200
Atlanta GA 30328
Agency Email: nnguyen@apollomd.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Cobb, Douglas and Paulding locations
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Right At Home
School of Nursing
Melita Lawson
Phone: (770) 343-6235
4625 Alexander Dr. Ste 210
Alpharetta GA 30022
Agency Email: melita@rah-northatl.com
Expiration Date: 2021-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-04
Requester Name: Traci Sims
Document 1: Right At Home_exp_04-030-2024
Document 2:
Document 3:
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Kindred Healthcare Operating, LLC (“Kindred”)
Byrdine F Lewis School of Nursing and Health Professions
Meeya Hill
Phone: (502) 596-7300
680 South Fourth Street
Louisville Kentucky 40202
Agency Email: scheduleyourclinical@kindred.com
Expiration Date: 2024-05-03
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-05
Requester Name: Shana Finks
Document 1: Kindred Healthcare Operating, LLC
Document 2:
Document 3:
Comment: Student would like to begin clinical rotation no later
than 5/17 in order to still graduate on schedule.
Student may have another option depending on timing of
contract. This contract would benefit multiple future
students across the country even if current student is
not able to complete a clinical rotation with this
company next semester.
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Joshuasom
Joshuasom JoshuasomJS
Phone: 83288994842
https://zootovaryvsems.site/post/cat+chow+urinary Kabul
Kabul Afghanistan 113133
Agency Email: uliseskodylgxa@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Joshuasom Joshuasom
Document 1:
Document 2:
Document 3:
Comment: https://zootovaryvsems.site/post/cat+chow+urinary - https://ic.pics.livejournal.com/shalenaolena/21982935/37303/37303_900.jpg
ðóíû ðîäà
ðóíû ïîáåäû
ðóíû äæåéñ
áàòþøêîâ ðóíû
ñòàâû ðóíû
äèâèàé ðóíû
ðóíà êðàäà
íîâûå ðóíû
ñêàðíåð ðóíû
ñåò ðóíû
https://zootovaryvsems.site/post/cat+chow+urinary - ðóíû äàðèóñ
ðóíû îðèàíà
ìàãèÿ ðóí
ìîðäà ðóíû
þìè ðóíû
ïàíòåîí ðóíà
ðóíà ñïîêîéñòâèÿ
ðóíû íàçâàíèÿ
ýêî ðóíû
ëîë ðóíû
ðóíû îáåðåãè
Hi all! ma favorite city is af621
94eegfdsf2df83b h596
https://zootovaryvsems.site/post/cat+chow+urinary
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Kaiser Foundation Helath Plan Georgia, Inc & The Southeast Permanente Medical Group, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Tina Smith
Phone: 4043643721
3495 Piedmont Road, NE
Atlanta Georgia 30305
Agency Email: Tina.M2.Smith@kp.org
Expiration Date: 2024-08-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-23
Requester Name: Anne Cadet
Document 1: Kaiser Foundation Health Plan
Document 2: MOU
Document 3:
Comment: The old MOU is attached - This MOU needs to be amended and
renewed. Please make sure the new MOU includes the
Associate Degree Nursing Program.
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Peachtree Womens Specialists
Byrdine F Lewis School of Nursing and Health Professions
Michele Brandt
Phone: 404-355-1285
3925 Peachtree Road Suite 240
Atlanta GA 30319
Agency Email: MBrandt@atlwhs.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Walton Foundation for Independence, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Cara Knollenberg
Phone: 706-823-8584
928 Walton Way
Augusta GA 30901
Agency Email: mailto:carac@waltonfoundation.net
Expiration Date: 2024-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-04
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Fieldwork will occur the last week of July for
approximately 8-10 students.
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UMG Internal Medicine Partners
Byrdine F Lewis School of Nursing and Health Professions
Sadiqa Walton
Phone: 706-792-5063
3121 Peach Orchard Road Suite 103
Augusta GA 30906
Agency Email: SadiqaWalton@uh.org
Expiration Date: 2024-04-30
Sent to Facility: 2024-04-11
Sent to Provost:
Sent to Legal:
Completed: 2021-04-30
Requester Name: Lisa Williams
Document 1: UMG Internal Medicine Partners_exp_04-30-2024
Document 2:
Document 3:
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Playworks pediatric therapy services. DBA- Sandra U Buttine, OTR
Department of Occupational Therapy
Sandy Buttine
Phone: 972 387 1100
12880 Hillcrest Road Suite 102
Dallas Texas 75230
Agency Email: Sandy.buttine @playworkspts.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: This is for a placement that will need to begin by May 17th. This is a small business that will accept the standard contract.
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Emory Rehab Hospital
Department of Occupational Therapy
Sharon Gaffney
Phone: 404 712 7804
1441 Clifton Road
Atlanta GA 30322
Agency Email: sharon.gaffney@emoryhealthcare.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Please update this as we are planning to send students on
8/21/24.
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Piedmont HealthCare, Inc
Byrdine F Lewis School of Nursing and Health Professions
Marci Hanson
Phone: (404) 985-8930
1968 Peachtree Road N.W
Atlanta GA 30309
Agency Email: marci.hanson@piedmont.org
Expiration Date: 2024-12-12
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-9-15
Requester Name: Anne Cadet-Baker
Document 1: Piedmont Healthcare Inc_exp_12-31-21
Document 2:
Document 3: Piedmont Healthcare, Inc_exp_12-12-2024
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Piedmont HealthCare, Inc
Byrdine F Lewis School of Nursing and Health Professions
Marci Hanson
Phone: (404) 985-8930
1968 Peachtree Road N.W
Atlanta GA 30309
Agency Email: marci.hanson@piedmont.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet-Baker
Document 1: Piedmont Healthcare Inc_exp_12-31-21
Document 2:
Document 3:
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Piedmont Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Niaira Taylor
Phone: 404-351-6662
105 Collier Road Suite 4060
Atlanta GA 30309
Agency Email: niaira.taylor@piedmontpediatrics.org
Expiration Date: 2024-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-05-25
Requester Name: Lisa Williams
Document 1: Piedmont Pediatrics_exp_04-30-2024
Document 2:
Document 3:
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Barrow Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Danell Gonzalez
Phone: 770-867-7616
561 Jefferson Hwy
Winder GA 30680
Agency Email: danell.bpediatrics@gmail.com
Expiration Date: 2024-04-30
Sent to Facility: 2024-04-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: Barrow Pediatrics_exp_04-30-2021
Document 2:
Document 3:
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Linsey Martin Physical Therapy LLC
Department of Physical Therapy
Linsey Martin
Phone: 214-417-2613
1094 River Mist Cr
Jefferson GA 30549
Agency Email: lmphysicaltherapyllc@gmail.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
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Reagan Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Sabrina Boyd
Phone: 678-546-9800
3685 Braselton Highway Suite 100
Dacula GA 30019
Agency Email: Sboydreagan@yahoo.com
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-17
Requester Name: Lisa Williams
Document 1: Reagan Medical Center
Document 2: view
Document 3:
Comment: Locations: Hamilton Mill, Five Forks, Johns Creek, Suwanee,
Grayson Hwy
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Decatur Health and Wellness
Byrdine F Lewis School of Nursing and Health Professions
Meyer Harrington
Phone: 678-705-8695
1370 Montreal Road Suite 112
Tucker GA 30084
Agency Email: mharringtonhwlc@gmail.com
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-06-15
Requester Name: Lisa Williams
Document 1: Decatur Health and Wellness_exp06-30-2024
Document 2:
Document 3:
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Howard Center for Womens Health
Byrdine F Lewis School of Nursing and Health Professions
Shara Greer
Phone: 229-391-3500
4143 Hospital Drive
Covington GA 30014
Agency Email: Shara.Greer@howardcenter.com
Expiration Date: 2025-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-06_exp_5-31-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Developmental Therapy Associates, Inc.
Department of Occupational Therapy
Evelyn Bonano
Phone: 919-465-3966
875 Walnut St. Suite 100
Cary North Carolina 27511
Agency Email: info@developmentaltherapy.com
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost: 2024-04-02
Sent to Legal:
Completed: 2021-06-23
Requester Name: Shana Finks
Document 1: Developmental Therapy Associates, Inc.
Document 2:
Document 3:
Comment: Student begins fieldwork clinical at this site April 25th
2022. Site is ready to complete the contract during summer
2021 and will use our standard contract.
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Milestone Pediatric Therapy Services, Inc.
Department of Physical Therapy
Beth Chambers
Phone: 706-367-1141
40 Professional Drive
Jefferson Georgia 30549
Agency Email: milestonepediatric@gmail.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-08
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Vickery Rose Retirement
School of Nursing
Anthony Washington
Phone: 470-550-5200
295 East Crossville Rd.
Roswell Georgia 30075
Agency Email: VKRMGR2@rlcommunities.com
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-08-04
Requester Name: Traci Sims
Document 1: Vickery Rose Retirement
Document 2:
Document 3:
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Texas Childrens Hospital
Department of Occupational Therapy
Jerryck Cunningham
Phone: 832-824-2852
1919 Braeswood MB 2244
Houston TX 77030-2399
Agency Email: jdcunnin@texaschildrens.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1: Texas Childrens Hospital
Document 2:
Document 3:
Comment: Mitzi Wiggin is listed as initial contact for requesting
and agreement -mmwiggin@texaschildrens.org
Site prefers to use their own MOU.
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Good Shepherd Rehabilitation Hospital
Department of Physical Therapy
Emily Thomas
Phone: 610-807-4239
850 S 5th St
Allentown PA 18103
Agency Email: EThomas@gsrh.org
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 on communication
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Ascension Sacred Heart Rehabilitation
Byrdine F Lewis School of Nursing and Health Professions
Wendy Miller
Phone: 850-416-2477
7720 US-98
Miramar Beach FL 32550
Agency Email: wendy.miller1@ascension.org
Expiration Date: 2025-01-25
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Wendy will send the Ascension contract after she receives
the following:Please send her the correct facility address,
the name and title for the person who has signatory
authority and lastly, the GSU W9.
Ascension Sacred Heart Rehabilitation agreement
automatically renews
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Neuro Behavioral Health Associates LLC
Byrdine F Lewis School of Nursing and Health Professions
Olufunke Adewunmi
Phone: 770-554-2999
367 Athens Hwy Suite 1800
Loganville GA 30052
Agency Email: olunp20@gmail.com
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-08-05
Requester Name: Lisa Williams
Document 1: Neuro Behavioral Health Associates LLC
Document 2:
Document 3:
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Georgia Southwestern State University
Byrdine F Lewis School of Nursing and Health Professions
Lynn Bailey
Phone: 229-931-2275
800 Georgia Southwestern State University Drive
Americus GA 31709
Agency Email: lynn.bailey@gsw.edu
Expiration Date: 2024-08-17
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-07
Requester Name: Anne Cadet
Document 1: Georgia Southwestern State University_MOU
Document 2: Georgia Southwestern State University_exhibit
Document 3:
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Memorial Drive Family Medicine, PC
Byrdine F Lewis School of Nursing and Health Professions
Tassew Tesfay
Phone: 404-809-2480
4958 Memorial Drive
Stone Mountain GA 30083
Agency Email: memorialfammed@yahoo.com
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-15
Requester Name: Lisa Williams
Document 1: Memorial Drive Family Medicine, PC
Document 2:
Document 3:
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Crescent Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Cho Moe
Phone: 408-356-1111
2504 Samaritan Drive
San Jose CA 95124
Agency Email: MCho@crescentmedicalcenter.com
Expiration Date: 2024-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-15
Requester Name: Lisa Williams
Document 1: Crescent Medical Center
Document 2:
Document 3:
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Pruitt Health
School of Nursing
Wendy Meinert
Phone: 678-533-6475
1626 Jerugens Court
Norcross Georgia 30093
Agency Email: wmeinert@pruitthealth.com
Expiration Date: 2024-09-20
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-10-13
Requester Name: Terri Hendry
Document 1: PruittHealth
Document 2:
Document 3:
Comment: Original date 9/21/21. Auto renews automatically at one year
intervals unless terminated.
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Pruitt Health
School of Nursing
Wendy Meinert
Phone: 678-533-6475
1626 Jerugens Court
Norcross Georgia 30093
Agency Email: wmeinert@pruitthealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Terri Hendry
Document 1: PruittHealth
Document 2:
Document 3:
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University of Oregon Athletic Department
Department of Nutrition
William Blood
Phone: 541-346-5539
2727 Leo Harris Parkway
Eugene OR 97401
Agency Email: wblood@uoregon.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Jessica Todd sent thier U of Oregon contract to Wanda
Little Aug 16th 2021 to route to Legal for review.
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ATI Physical Therapy
Department of Physical Therapy
Thomas Denninger
Phone: 203.243.4888
18 E. North St
Greenville SC 29601
Agency Email: Thomas.denninger@atipt.com
Expiration Date: 2024-10-31
Sent to Facility: 2024-03-25
Sent to Provost:
Sent to Legal:
Completed: 2021-11-01
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Carla emailed MOU on 8/17/21 to be forwarded to legal for review.
Please copy ptclinicaleducation@gsu.edu
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Friends of Disabled Adults and Children (FODAC)
Byrdine F Lewis School of Nursing and Health Professions
Bryan Clever
Phone: 17704919014
4900 Lewis Rd.
Tucker GA 30083
Agency Email: chrisbrand@fodac.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1: Friends of Disabled Adults and Children
Document 2:
Document 3:
Comment: Please send all MOU Communications to both: chrisbrand@fodac.org and
bryanclever@fodac.org. The MOU database shows that Cedric Truss initiated a
contract in 2018 that was never finished. FODAC agreed to complete this MOU
ASAP. We have students starting in September,so Carolyn Podolski has asked that
this MOU be rushed to be completed as quickly as possible via standard contract.
Please contact her if there are questions or concerns. Thanks so much!
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Golden Isles Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Patsy Hill
Phone: 229-868-7342
144 East Oak Street
McRae GA 31055
Agency Email: patsy.hill@goldenisleshc.com
Expiration Date: 2024-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Purposeful Fueling LLC
Department of Nutrition
Beth McCall
Phone: 920-285-6270
5008 Fortunes Ridge Drive
Durham NC 27713
Agency Email: beth@purposefulfueling.com
Expiration Date: 2024-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-15
Requester Name: Jessica Todd
Document 1: Purposeful Fueling LLC
Document 2:
Document 3:
Comment: non clinical virtual rotation
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Athiya Javid MD
Byrdine F Lewis School of Nursing and Health Professions
Athiya Javid
Phone: (408) 729-8111
200 Jose Figueres Avenue Ste 320
San Jose CA 95116
Agency Email: jaymedicalgroup@gmail.com
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Zaman Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Cindy Zimmerman
Phone: 770-979-2600
2800 Main St West
Snellville GA 30078-3157
Agency Email: cindy@zamanpediatrics.com
Expiration Date: 2025-02-25
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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MedStar National Rehabilitation Network
Department of Occupational Therapy
Patricia Brown
Phone: 202-877-1000
102 Irving Street NW
Washington DC 20010
Agency Email: Patricia.g.brown@medstar.net
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-03
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Student starts clinical placement on April 25, 2022
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Memorial Health Meadows Hospital
School of Nursing
Shannon Brantley
Phone: (912)277-2044
One Meadows Parkway
Vidalia, GA 30474
Agency Email: Shannon.Brantley@hcahealthcare.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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KirkXnLRileEmite
KirkXnLRileEmite KirkXnLRileEmiteFQ
Phone: 84341918342
http://karta-xalva.ru/ Ðîñòîâ
Ðîñòîâ Ðîññèÿ 133524
Agency Email: antonserebrov867@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: KirkXnLRileEmite KirkXnLRileEmite
Document 1:
Document 2:
Document 3:
Comment: Ïëàíèðóåòå áîëüøèå ïîêóïêè? Âûãîäíûå óñëîâèÿ, âû ìîæåòå îôîðìèòü http://sovestcard.ru/ â ëþáîì îòäåëåíèè áàíêà. Âàì íå íóíî áóäåò æäàòü çàâòðà!
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Alpha OBGYN Inc
Byrdine F Lewis School of Nursing and Health Professions
Ramya Janakiraman
Phone: 678-335-9223
2905 Jordan Court Suite G
Alpharetta GA 30004
Agency Email: officeadmin@alphaobgyn.com
Expiration Date: 2024-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-09-17
Requester Name: Lisa Williams
Document 1: Alpha OBGYN Inc
Document 2:
Document 3:
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Spencer Family Medicine and Aesthetics
Byrdine F Lewis School of Nursing and Health Professions
Cheryl Fountain
Phone: 770-607-9032
650 Henderson Drive Suite 504
Cartersville GA 30120
Agency Email: SpencerFamilyMedicine@gmail.com
Expiration Date: 2024-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-11-11
Requester Name: Lisa Williams
Document 1: Spencer Family Medicine and Aesthetics
Document 2:
Document 3:
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Ochsner Health
Byrdine F Lewis School of Nursing and Health Professions
Melissa McDowell
Phone: 504-703-9360
1514-A Jefferson Highway
New Orleans LA 70121
Agency Email: mmcdowell@ochsner.org
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-10-20
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment: IMPORTANT: see email message
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Dr. Nannette Cook Gynecologist
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Hardimon
Phone: 770-431-2322
3692 Highlands Parkway
Smyrna GA 30082
Agency Email: Admin@cookgyn.com
Expiration Date: 2024-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3: Dr. Nannette Cook Gynecologist
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East Georgia Regional Medical Center
Department of Physical Therapy
Michelle Woods
Phone: (912) 486-1000
1499 Fair Rd.
Statesboro GA 30458
Agency Email: michelle.woods@eastgeorgiaregional.com
Expiration Date: 2024-11-30
Sent to Facility: 2024-03-19
Sent to Provost:
Sent to Legal:
Completed: 2021-11-1
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Copy ptclinicaleducation@gsu.edu
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Atlanta Plus Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Savonia Grant
Phone: 770-679-4360
2121 Salem Road SE
Conyers GA 30012
Agency Email: savoniagrant@yahoo.com
Expiration Date: 2024-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-10-13
Requester Name: Lisa Williams
Document 1:
Document 2: Atlanta Plus Urgent Care
Document 3:
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WellMed/Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Roger Carter II
Phone: 678-522-6086
3469 Lawrenceville Highway Ste. 103
Tucker GA 30084
Agency Email: carterr@wellmedatlanta.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1: City to City Psychiatry dba WellMed_Atlanta
Document 2:
Document 3:
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Pediatric Otolaryngology – Head and Neck Surgery at Children’s Hospital of Richmond at VCU
Byrdine F Lewis School of Nursing and Health Professions
Susan Bodin
Phone: 804.828.3966
1000 E Broad Street
Richmond VA 23219
Agency Email: susan.bodin@vcuhealth.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Greater Atlanta Family Counseling
Byrdine F Lewis School of Nursing and Health Professions
Williams Smith
Phone: 770-421-5271
165 DeKalb Industrial Way Suite D-1
Decatur GA 30030
Agency Email: Wsmith@gafamilycounseling.com
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Excel Rehab and Sports
Department of Physical Therapy
Jeremy Shook
Phone: 1.423.254.5461
2158 Northgate Park Lane Suite 200
Chattanooga TN 37415
Agency Email: jshook@excelrehabsports.com
Expiration Date:
Sent to Facility: 2021-10-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu on email to facility
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The Nutrition Clinic for Digestive Health
Department of Nutrition
Rachel Silva
Phone: 334-301-3437
295 West Crossville Road, Suite 620 Roswell, GA 30075
Roswell Georgia 30075
Agency Email: rachel@digestiontherapy.com
Expiration Date: 2026-1-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-21
Requester Name: jessica todd
Document 1:
Document 2:
Document 3:
Comment: Clinical Agreement
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Crosslinks Family Practice & Vein Center
Byrdine F Lewis School of Nursing and Health Professions
Alicia Ash
Phone: 404-296-8500
1475 Montreal Road East
Tucker GA 30084
Agency Email: info@crosslinksfp.com
Expiration Date: 2024-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-11-04
Requester Name: Lisa Williams
Document 1: Crosslinks Family Practice & Vein Center
Document 2:
Document 3:
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Gwinnett County School District - Board of Regents of University System of Georgia
Byrdine F Lewis School of Nursing and Health Professions
Kim Baumann
Phone: (404) 413-1181
437 Old Peachtree Road NW,
Suwanee GA 30024
Agency Email: kim.baumann@gcpsk12.org
Expiration Date: 2024-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-07-12
Requester Name: Anne Cadet
Document 1: Gwinnett County School District
Document 2:
Document 3:
Comment: 4/5/22 - requesting renewal
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Vizzia Technologies
Health Informatics
Jim Forbes
Phone: 404-735-9899
715 Peachtree St NE 100
Atlanta GA 30308
Agency Email: jim.forbes@vizziatech.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
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Health Care Program Advisors
Health Informatics
Brittany Wulf
Phone: 770 – 919 - 2273
65 Whitlock Ave SW
Marietta GA 30064
Agency Email: Brittany.wulf@prgramadvisors.com
Expiration Date: 2024-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-12-08
Requester Name: Dr.Cedric Truss
Document 1:
Document 2:
Document 3:
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Foster4Love
Department of Occupational Therapy
Jen Moody
Phone: 770.558.5491
1301 Shiloh Rd #1630
Kennesaw GA 30144
Agency Email: office@foster4love.com
Expiration Date: 2025-01-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-04
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Completion of this contract is needed by December for several
students to start in 2022.
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Brookhaven Innovation Academy
Byrdine F Lewis School of Nursing and Health Professions
Julie Tolbert
Phone: 7705381550
186 Hunter Street
Norcross GA 30071
Agency Email: jtolbert@biaschool.org
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-11-01
Requester Name: Anne Cadet
Document 1: Brookhaven Innovation Academy
Document 2:
Document 3:
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Mansions of Alpharetta Independent Living
School of Nursing
Bonnie Galluccio
Phone: 4703652800
3700 Brookside Pkwy
Alpharetta GA 30022
Agency Email: BGalluccio@MansionsSeniorLiving.com.
Expiration Date: 20204-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-11-01
Requester Name: Wanda Little
Document 1: Mansions of Alpharetta Independent Living
Document 2:
Document 3:
Comment: Contact person Susan Brown susan@rah-northatl.com
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Village Park Senior Living
School of Nursing
Lauren Thomas
Phone: 470-509-4557
555 Wills Road
Alpharetta, GA 30009
Agency Email: laurenthomas@vpsl.com
Expiration Date:
Sent to Facility: 2021-10-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
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Integrity Psychiatry and Wellness
Byrdine F Lewis School of Nursing and Health Professions
Lois Schwarz
Phone: 404-998-3795
108 E. Ponce de Leon Avenue Suite 212
Decatur GA 30030
Agency Email: lschwarze1@gsu.edu
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Dalton State College
Byrdine F Lewis School of Nursing and Health Professions
Patricia Findley
Phone: 706-272-2658
650 College Drive
Dalton GA 30720
Agency Email: pfindley@daltonstate.edu
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Clarke County School District
Department of Nutrition
Paula Farmer
Phone: 706-354-1138 ex. 77351
145 Paradise Blvd
Athens ga 30607
Agency Email: farmerp@clarke.k12.ga.us
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-03
Requester Name: Kate Wiley
Document 1:
Document 2:
Document 3:
Comment: This is a non clinical agreement.
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Stepping Stones Psychiatric Care
Byrdine F Lewis School of Nursing and Health Professions
Julie Burke
Phone: 678-552-2713
318 Newman Road
Carrollton GA 30117
Agency Email: jburke197138@yahoo.com
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-11
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Lactation Consultants of Atlanta, INC
Department of Nutrition
Jana Birdseye
Phone: 770-644-0555
2141 Kingston CT SE 103
Marietta GA 30067
Agency Email: ibclc@breastfeedingatlanta.com
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-12-08
Requester Name: jessica todd
Document 1: Lactation Consultants of Atlanta INC
Document 2:
Document 3:
Comment: Clinical Agreement
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Columbus State University
Byrdine F Lewis School of Nursing and Health Professions
Jessica Bauer
Phone: 706-507-8588
4225 University Avenue
Columbus GA 31907
Agency Email: Bauer_jessica@columbusstate.edu
Expiration Date: 2024-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-3-3
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Rainbow Pediatric Clinic, LLC
Byrdine F Lewis School of Nursing and Health Professions
Aarti Raina
Phone: 770-781-1606
1735 Buford Hwy Suite 225
Cumming GA 30041
Agency Email: araina@rainbowpedclinic.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Tucker Medical Associates of Georgia
Byrdine F Lewis School of Nursing and Health Professions
Amber Syed
Phone: 770-938-5552
1462 Montreal Road Suite 307
Tucker GA 30084
Agency Email: backoffice@medassocga.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:
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Greenwood Obstetrics & Gynecology, P.A.
Byrdine F Lewis School of Nursing and Health Professions
Denise Balentine
Phone: 864-227-6371
106 Liner Drive
Greenwood SC 29646
Agency Email: dbalentine@gwdobgyn.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2021-12-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Village Medical at Morrow Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Lizeth Gomez
Phone: 770-781-8004
3970 Deputy Bill Cantrell Memorial Road Suite 150
Cumming GA 30040
Agency Email: westforsythinternalmedicine@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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The Walk In Clinic
Byrdine F Lewis School of Nursing and Health Professions
Tanya Jefferson
Phone: 770-929-9150
2890 Hwy 212 Suite E
Conyers GA 30094
Agency Email: thewalkinclinic@gmail.com
Expiration Date:
Sent to Facility: 2022-01-10
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Douglas County School System
Department of Nutrition
Danielle Freeman
Phone: 770-651-2314
11490 Veterans Memorial Hwy
douglasville Georgia 30134
Agency Email: William.conrad@dcssga.org
Expiration Date:
Sent to Facility: 2022-01-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non clinical agreement
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Athens Neuro and Balance Rehabilitation
Department of Physical Therapy
Patty Hopaluk-Gay
Phone: 706-549-7400
1088 Baxter St Suite C
Athens GA 30606
Agency Email: Patty@athenspt.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-22
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
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West Forsyth Internal Medicine, P.C.
Byrdine F Lewis School of Nursing and Health Professions
A. Brook Santizo
Phone: 770-415-2515
5971 Parkway North Blvd
Cumming GA 30040
Agency Email: westforsythinternalmedicine@gmail.com
Expiration Date: 2025-12-31
Sent to Facility: 01/11/2022
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Pediatric Partners of Gwinnett
Byrdine F Lewis School of Nursing and Health Professions
Sonia Varghese
Phone: 770-923-6400
4120 Five Forks Trickum Road
Lilburn GA 30047
Agency Email: Sonia.varghese@gwinnettchildren.org
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Inserra Supermarkets, Inc.
Department of Nutrition
Dana McLaughlin
Phone: 9735342052
20 Ridge Road
Mahwah NJ 07430
Agency Email: dana.mclaughlin@wakefern.com
Expiration Date: 2025-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-11
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: non-clincal
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NAPA Center
Department of Physical Therapy
Lisa Murphy
Phone: (720) 791-2881
11211 E. Arapahoe Road Unit 118
Centennial CO 80112
Agency Email: lisa@napacenter.org
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-04
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu on communication
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Baltimore Orioles
Department of Nutrition
Nick White
Phone: 6789104214
333 West Camden Street
Baltimore MD 21201
Agency Email: nwhite@orioles.com
Expiration Date:
Sent to Facility: 2024-03-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clincial Agreement
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Professional Park Medical Services PC
Byrdine F Lewis School of Nursing and Health Professions
Sebastian Mason
Phone: 770-832-6891
100 Professional Place Suite 202
Carrollton GA 30117
Agency Email: mason.ppms@gmail.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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3:16 Healthcare
Noelle Smith
Phone: 770-537-1234
222 Gordon Street
Bremen GA 30110
Agency Email: NSmith@316healthcare.us
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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RightStart Therapy Services, Inc.
Department of Occupational Therapy
Lara Adams
Phone: 770-995-9600
2295 Henry Clower Blvd Suite 100
Snellville GA 30078-6163
Agency Email: info@rightstarttherapyservices.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-04
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Please RUSH this contract.
Student starts clinical rotation on 2/7/22.
This site is to replace a cancellation.
Contract covers Snellville and Athens locations.
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Duluth Urgent Care
Byrdine F Lewis School of Nursing and Health Professions
Caitlin Tilden
Phone: 678-821-5377
2320 Peachtree Industrial Boulevard Suite 101
Duluth GA 30097
Agency Email: manager@advanceduca.com
Expiration Date: 2025-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Nova Medical Services, LLC
Byrdine F Lewis School of Nursing and Health Professions
Richard Glass
Phone: 404-858-1063
20 Herrell Road
Villa Rica GA 30180
Agency Email: rglass@tanner.org
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-09
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Commerce Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Valerie Swafford
Phone: 706-335-7909
687 Hospital Road
Commerce GA 30529
Agency Email: valerieswafford115@gmail.com
Expiration Date: 2025-01-31
Sent to Facility: 2022-02-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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iCareAssociates LLC
Byrdine F Lewis School of Nursing and Health Professions
Jamil Davis
Phone: 770-217-5168
7574 Highway 85
Riverdale GA 30274
Agency Email: iCareAssociatesLLC@gmail.com
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-02-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Thrive Skilled Pediatric Care
Department of Respiratory Therapy
Jamie Colston
Phone: 800 926 1103
1018 U.S. Highway 80 West Unit 404
Pooler GA 31322
Agency Email: JColston@thrivespc.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Chip Zimmerman
Document 1:
Document 2:
Document 3:
Comment: The site reached out to us to work with students, and has a
question regarding whether or not our students can ride with
their therapists while making home/hospital visits or if
students will be required to provide their own
transportation. Thanks!
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Ortho Virginia
Byrdine F Lewis School of Nursing and Health Professions
Kelly Koogler
Phone: 804-915-1910
1115 Boulders Parkway 100
N. Chesterfield VA 23225
Agency Email: Kelly.koogler@orthovirginia.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Someone Cares
Byrdine F Lewis School of Nursing and Health Professions
Maria Bell
Phone: 678-921-2706
1950 Spectrum Circle Suite 200
Marietta GA 30067
Agency Email: Mariabell@s1catl.org
Expiration Date: 2025-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Playground Childrens Therapy, LLC
Department of Occupational Therapy
NICOLE KNIGHT
Phone: (478) 333-2333
208 SMITHVILLE CHURCH ROAD
WARNER ROBINS GA 31088
Agency Email: INFO@PCTGA.COM
Expiration Date:
Sent to Facility: 2022-03-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: Student starts her 12 week clinical fieldwork rotation at this
location on April 25th. This is a quick turn around MOU as
the site wishes to use our standard contract.
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Clínica Mi Familia Seebaby
Byrdine F Lewis School of Nursing and Health Professions
Ed T. Cota
Phone: (770) 613-0670
5050 Jimmy Carter Blvd Suite 250
Norcross, GA GA 30093
Agency Email: cotaman22@gmail.com
Expiration Date:
Sent to Facility: 2023-03-03
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Womens Health Associates of Walton PC
Byrdine F Lewis School of Nursing and Health Professions
Lara Hannay
Phone: (770) 267-8368
513A Great Oaks Dr
Monroe GA 30655
Agency Email: whawmonroega@aol.com
Expiration Date: 2025-03-14
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-03-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Encompass Health Rehabilitation Hospital of Cumming
Byrdine F Lewis School of Nursing and Health Professions
Michael Boscia
Phone: 470.533.4223
1165 Sanders Road
Cumming georgia 30041
Agency Email: Michael.Boscia@encompasshealth.com
Expiration Date: 2025-01-11
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-01-24
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
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North Augusta Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Jameka Hankinson
Phone: 803-510-0007
140 Allen Court
North Augusta SC 29860
Agency Email: jhankinson@napeds.pcc.com
Expiration Date: 2025-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-5
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Anthem, Inc.
Health Informatics
Peter LaFave
Phone: 805-448-5849
4553 La Tienda Dr. CAT 101-H003
Thousand Oaks CA 91362
Agency Email: peter.lafave@anthem.com
Expiration Date: 2025-05-17
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-13
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: Could this be a general MOU versus a fully clinical MOU for the
Health Informatics programs (BIS, Grad Cert, MSHS),
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Georgia Department of Public Health North Georgia Health District 1-2
Byrdine F Lewis School of Nursing and Health Professions
Ylonda Campbell
Phone: 706.529.5757 Ext. 13011
1710 Whitehouse Court
Dalton GA 30720
Agency Email: ylonda.campbell@dph.ga.gov
Expiration Date: 2027-03-31
Sent to Facility:
Sent to Provost: 2024-03-20
Sent to Legal:
Completed: 2024-03-25
Requester Name: Lisa Wiliams
Document 1:
Document 2:
Document 3:
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Monroe Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
MacKenzie Toney
Phone: 770-207-7916
517 Great Oaks Drive
Monroe GA 30655
Agency Email: Mackenzietoney9@gmail.com
Expiration Date: 2025-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-20
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta Independent School System
Byrdine F Lewis School of Nursing and Health Professions
Marilyn Hughes
Phone: 404-802-1599
130 Trinity Avenue
Atlanta GA 30303
Agency Email: mhhughes@atlanta.k12.ga.us
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anita Nucci
Document 1:
Document 2:
Document 3:
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The Howard Center for Womens Health - Tifton
Byrdine F Lewis School of Nursing and Health Professions
Kristin Merritt
Phone: 229-391-3500
1948 Old Ocilla Road
Tifton GA 31794
Agency Email: kristin.merritt@howardcenter.com
Expiration Date:
Sent to Facility: 2022-05-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kool Kidz
Department of Occupational Therapy
Heather Kontos
Phone: 678-503-8702
2850 Johnson Ferry Rd
Marietta GA 30062
Agency Email: contactus@koolkidzpt.com
Expiration Date: 2025-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-05-31
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Greenwillow Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Seema Bisht-Nadler
Phone: 678-450-0747
3030 McEvers Road Suite 130
Gainesville GA 30504
Agency Email: none@gmail.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-06-22
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Wanda - please forward contract to me and I will fax to the
provider. Thanks. Lisa
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Greater Athens Physicians, Inc.
Department of Nutrition
Carrie Mizerak
Phone: 706-296-1709
129 Main Street
Bogart Ga 30622
Agency Email: cmizerak@athensgapi.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-08
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical Agreement
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Greater Athens Physicians, Inc.
Department of Nutrition
Carrie Mizerak
Phone: 706-296-1709
129 Main Street
Bogart Ga 30622
Agency Email: cmizerak@athensgapi.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical Agreement
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Cobblestone Therapy Group
Byrdine F Lewis School of Nursing and Health Professions
Alyssa Yount
Phone: (770) 998-9599
12060 Etris Road Ste F-100
Roswell Georgia 30075
Agency Email: alyssa@cobblestonetherapy.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-8
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Caduceus USA
Byrdine F Lewis School of Nursing and Health Professions
Thomas Grondin
Phone: 727-687-0726
535 North Central Avenue
Hapeville GA 30354
Agency Email: tgrondin@caduceusoccmed.com
Expiration Date: 2025-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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SP-OT On Therapy Group, LLC
Byrdine F Lewis School of Nursing and Health Professions
Crystal M. Donaldson
Phone: (770) 559-9498
1726 Oakbrook Lake Drive
Norcross GA 30093
Agency Email: spoton2021@spotontg.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-07-20
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
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Buford Kids SPOT
Department of Occupational Therapy
Deborah Hughes
Phone: 404-358-2640
2140 Buford Highway 109
Buford GA 30518
Agency Email: BufordKidsSpot@gmail.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-08
Requester Name: Shana Finks
Document 1:
Document 2:
Document 3:
Comment: This is not the same as the one I submitted last week though
their names are similar SF
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AbsoluteCare
Byrdine F Lewis School of Nursing and Health Professions
Christopher Walton
Phone: 404-231-4431
2140 Peachtree Road NW Suite 232
Atlanta GA 30309
Agency Email: cwalton@absolutecare.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Hight Health
Health Informatics
Terrence Hight
Phone: (404) 788 - 4429
1700 Northside Drive Suite A7, #5821
Atlanta GA 30318
Agency Email: terrence@hight.health
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-15
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
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Therapy Partner Solutions Holdings, LLC
Byrdine F Lewis School of Nursing and Health Professions
Thomas McLeod
Phone: (706) 868-1707
5003 Steiner Way- Suite
Grovetown GA 30813
Agency Email: tsmcleod@evansrehab.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
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Focus Factory Pediatric Occupational Therapy
Department of Occupational Therapy
Karen Corby
Phone: 770-767-1971
800 Old Dawson Village Road. 010
Dawsonville GA 30534
Agency Email: Office@focusfactoryot.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-18
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Morehouse School of Medicine
Department of Nutrition
Carla Moore
Phone: 404-756-5037
740 Westview Drive SW Bldg F-G35
Atlanta GA 30310
Agency Email: camoore@msm.edu
Expiration Date: 2025-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-27
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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University of Colorado Boulder
Department of Nutrition
Dana Bielinski
Phone: 303-492-9675
2150 Stadium Drive Department of Intercollegiate Athletics
Boulder Colorado 80309
Agency Email: Dana.Bielinski@colorado.edu
Expiration Date: 2025-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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PediaSpeech
Byrdine F Lewis School of Nursing and Health Professions
Maria OFarrell
Phone: (770)209-9826
495 Winn Way
Decatur GA 30030
Agency Email: mofarrell@pediaspeech.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-08-26
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
Comment: 770-209-9826 Ext. 48
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The Joshua Tree
Department of Occupational Therapy
Krista Grasser
Phone: 6784293790
3750 Palladian Village Drive Suite 210
Marietta GA 30066
Agency Email: krista.grasser@gmail.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-12
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Tongue Tie Laser Center of Atlanta
Department of Occupational Therapy
Amelia Persaud
Phone: 470-437-4337
400 Embassy Row Suite 150
Atlanta GA 30328
Agency Email: ameliaot@tonguetiecenteratl.com
Expiration Date:
Sent to Facility: 2022-08-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Occupational Therapy Training Program - San Francisco
Department of Occupational Therapy
Lex Phomvongsa
Phone: 4155510975
425 Divisadero Street Suite 300
San Francisco CA 94117
Agency Email: lex.phomvongsa@ottp-sf.org
Expiration Date: 2025-8-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-12
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Hirsch Academy
Department of Occupational Therapy
Shelley Carnes
Phone: 404-378-9706
705 South Candler Street
Decatur GA 30030
Agency Email: info@hirschacademy.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-07-15
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Cartersville Ob/Gyn Associates
Byrdine F Lewis School of Nursing and Health Professions
Janet Rosser
Phone: 770-386-4824
958-A Joe Frank Harris Parkway Building 2 Suite 102
Cartersville GA 30120
Agency Email: Jrosser@cartersvilleobgyn.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Field Trip Health, GA, PC
Byrdine F Lewis School of Nursing and Health Professions
Michael Muench
Phone: 305-323-7116
750 Glenwood Avenue SE Bldg. 200 Suite 210
Atlanta GA 30316
Agency Email: michael.muench@fieldtriphealth.com
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Therapy & Learning Center of GA
Department of Occupational Therapy
Ellen Terrell
Phone: (678) 824-2145
11285 Elkins Road Suite G2
Roswell GA 30076
Agency Email: info@TLCGeorgia.com
Expiration Date: 2025-9-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-26
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment: 2 locations: Roswell and Kennesaw
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Forsyth County Food and Nutrition Services
Department of Nutrition
Taylor Blake
Phone: 770-887-3473 EX 310305
136 Almon C Hill Dr
cumming GA 30040
Agency Email: bltaylor@forsyth.k12.ga.us
Expiration Date: 2025-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-12
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical Agreement
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Balance Behavioral Health
Byrdine F Lewis School of Nursing and Health Professions
Pamela Chanin
Phone: 404-736-1410
1010 Huntcliff NE Suite 1230
Atlanta GA 30350
Agency Email: info@balancebehavioral.health
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Norwood Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Allson Miller
Phone: 678-358-5933
1136 Cleveland Avenue Suite 308
East Point GA 30344
Agency Email: allison.np@norwoodpediatrics.org
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-09-26
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 9/9 - Contract sent out by LYW. This is just to put site in
database
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Devereux Advanced Behavioral Health Georgia
Byrdine F Lewis School of Nursing and Health Professions
Elizabeth Shirk
Phone: 770-427-0147
1291 Stanley Road NW
Kennesaw GA 30152
Agency Email: BethShirk3b@gmail.com
Expiration Date: 2025-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Moon River Therapy
Department of Occupational Therapy
Laura Desantis
Phone: 770-977-6866
7440 Highway 92
Woodstock GA 30189
Agency Email: info@moonrivertherapy.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Atlanta Womens Specialty Group
Byrdine F Lewis School of Nursing and Health Professions
Nannette Camacho
Phone: 678-500-1066
2678 Buford Highway NE
Atlanta GA 30324
Agency Email: nannettec@npclinicalsassist.com
Expiration Date: 2025-09-30
Sent to Facility: 2024-02-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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JOY Therapy & Learning Center
Department of Occupational Therapy
McKenzie MacAllister
Phone: 770-240-0163
1715 Friendship Circle Suite 300
Cumming Georgia 30028
Agency Email: info@joytlc.com
Expiration Date:
Sent to Facility: 2022-10-13
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Dr Miguel Cossio MD-PC
Byrdine F Lewis School of Nursing and Health Professions
Tina Greenway
Phone: 706-342-9664
1075 S Main St STE 400
Madison GA 30650
Agency Email: GreenwayT@bellsouth.net
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Cabarrus Rowan Community Health Centers
Byrdine F Lewis School of Nursing and Health Professions
Jamie Stevens
Phone: 704-792-2242
202 McGill Ave NW
Concord NC 28028
Agency Email: jstevens@crchc.org
Expiration Date: 2025-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-12-14
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Prospect Behavioral Pediatrics and Psychiatry
Byrdine F Lewis School of Nursing and Health Professions
Angie Trombley
Phone: 828-552-3504
600 Julian Lane Suite 640
Arden NC 28704
Agency Email: aktrombley76@gmail.com
Expiration Date: 2026-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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NANA Healthcare Management
School of Nursing
Justine Robinson
Phone: 770-238-2674
4828 Ashford Dunwoody Road 3rd Floor
Dunwoody GA 30338
Agency Email: justine@nanamgmt.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Covers Dunwoody Behavioral Health, Atlanta Recovery Place &
Southern Live Oak Wellness. LYW
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Moon River Therapy
Department of Occupational Therapy
Laura Desantis
Phone: 7702122170
7440 Highway 92
Woodstock GA 30189
Agency Email: laura@moonrivertherapy.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Acworth Primary Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Zarana Patel
Phone: 770-529-7478
4465 Lemon Street
Acworth GA 30101
Agency Email: acworthprimaryhealthcare@gmail.com
Expiration Date: 2025-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-02
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Grady Health System IT Department
Health Informatics
Mindy Oberg
Phone: 404-556-2336
80 Jesse Hill Jr. Dr.
Atlanta GA 30303
Agency Email: mmoberg@gmh.edu
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-18
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
Comment: This should be a non clinical affiliation agreement.
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Russell Medical
Byrdine F Lewis School of Nursing and Health Professions
Tonya Smith
Phone: 770-771-5050
4355 Browns Bridge Rd
Cumming GA 30041
Agency Email: tyms71@msn.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-27
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Childrens Wellness Center
Byrdine F Lewis School of Nursing and Health Professions
Stephanie Toole
Phone: 404-303-1314
5883 Glenridge Drive NE Suite 100
Sandy Springs GA 30328
Agency Email: stephls13@gmail.com
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Alliance Family Care LLC
Byrdine F Lewis School of Nursing and Health Professions
Kimberly Bennett
Phone: 770-255-0123
1775 Access Road Suite C
Covington GA 30014
Agency Email: kimberly@alliancefamilycare.com
Expiration Date:
Sent to Facility: 2022-12-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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IRONWOOD | a Marsh & McLennan Agency LLC Company
Department of Nutrition
Sara Shanahan
Phone: 470-558-7462
4401 Northside PKWAY 800
Atlanta GA 30327
Agency Email: sshanahan@ironwoodins.com
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-31
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Non clinical agreement, first student scheduled for Feb.
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TempleMedHealth
Byrdine F Lewis School of Nursing and Health Professions
Nakia Fields
Phone: 770-462-1170
503 Main Street
Villa Rica GA 30179
Agency Email: templemedhealth@yahoo.com
Expiration Date: 2026-01-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-23
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sodexo - Crestview Health & Rehabilitation
Department of Nutrition
Katherine Bechdol
Phone: 404-309-5937
2800 Springdale Rd SW
Atlanta Georgia 30315
Agency Email: Katherine.bechdol@sodexho.com
Expiration Date:
Sent to Facility: 2023-01-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical
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DL Dietetics
Department of Nutrition
Danielle Lewis
Phone: 678-236-2164
2485 Appalachee Dr NE
Brookhaven GA 30319
Agency Email: dlewisrd@gmail.com
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Carroll County Schools
Department of Nutrition
Bridgett Cross
Phone: 678-854-2313
164 Independent Drive
Carrolton Ga 30117
Agency Email: bridgett.cross@carrollcountyschools.com
Expiration Date: 2026-12-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-25
Requester Name: jessica todd
Document 1:
Document 2:
Document 3:
Comment: Non Clinical
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Veritas Collaborative
Byrdine F Lewis School of Nursing and Health Professions
Katherine Norris
Phone: 855-875-5812
41 Perimeter Center East Suite 250
Dunwoody GA 30346
Agency Email: Katherine.norris@accanto.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sawdust Occupational Therapy
Department of Occupational Therapy
Benjamin Keeling
Phone: 404-436-7416
11660 Alpharetta Hwy suite 400
Roswell GA 30076
Agency Email: ben@sawdustot.com
Expiration Date: 2026-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-10
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Griffin OB-GYN Clinic
Byrdine F Lewis School of Nursing and Health Professions
Taylor Chastain
Phone: 770-227-5505
503 S.8th Street
Griffin GA 30224
Agency Email: tchastain@griffinobgyn.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Winston Psychiatry Integrative Medicine
Byrdine F Lewis School of Nursing and Health Professions
Deana Robinson
Phone: 770-457-7994
4546 Barclay Drive
Dunwoody GA 30338
Agency Email: client.services@georgiabehavioral.com
Expiration Date:
Sent to Facility: 2023-01-18
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Encompass Health Rehabilitation Hospital of Savannah
Department of Occupational Therapy
Dana Edwards
Phone: 912 235-6023
6510 Seawright Drive
Savannah GA 31406
Agency Email: Dana.Edwards@encompasshealth.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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View Point Health
School of Nursing
Parul Bakshi
Phone: (770) 616-8148
175 Gwinnett Drive
Lawrenceville GA 30046
Agency Email: parul.bakshi@vphealth.org
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-21
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: This contract is specific to chosen precepted nursing
students. Please do not add ALL schools to this contract. It
will not be signed. This facility hand-picks the students they
want. They do not allow cohorts.
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District 4 Health Department
Department of Nutrition
Wendy LeVan
Phone: 770-714-8093
70 Hospital Road
Newnan Georgia 30263
Agency Email: GWENNA.EGART@DPH.GA.GOV
Expiration Date: 2026-02-05
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-12
Requester Name: Jessica Johnson
Document 1:
Document 2:
Document 3:
Comment: Clinical
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Georgia Institute of Technology - Tech Dining
Department of Nutrition
Heather Petty
Phone: 404-894-4812
760 Spring Street NW Suite 324
Atlanta Georgia 30332-0495
Agency Email: asklegal@gatech.edu
Expiration Date: 2026-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-18
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Overtime Elite Academy
Department of Nutrition
Shawn Pitcher
Phone: 607-221-7514
230 17th St. NW
Atlanta GA 30363
Agency Email: sportsrd607@gmail.com
Expiration Date:
Sent to Facility: 2023-01-30
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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The Nutrition Clinic for Digestive Health
Department of Nutrition
Jenny Askew
Phone: 757-869-9951
4555 Mansell Road Suite 300
Alpharetta GA 30022
Agency Email: jenny@bfan.us
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Clinical
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Rehab and Beyond
Department of Occupational Therapy
Stan Maddox
Phone: 833-887-3422
3983 Lavista Rd. Suite 128
Tucker GA 30084
Agency Email: stanmaddox@rehabandbeyond.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Michael Hilton, MD
Byrdine F Lewis College of Nursing and Health Professions
April Binion
Phone: 404-352-4001
3565 Piedmont Rd NE 3565 Piedmont Rd NE, building 4, suite 380
Atlanta GA 30305
Agency Email: office@michaelhiltonmd.com
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-02-21
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sprocket Therapy Solutions
Department of Occupational Therapy
Natalie Udwin
Phone: 4049460210
270 Carpenter Drive Suite 140
Atlanta GA 30328
Agency Email: nat@sprockettherapy.com
Expiration Date:
Sent to Facility: 2023-02-07
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Milton Brown & Associates, Inc. dba Eastchester Family Services
School of Nursing
Milton Brown
Phone: 404-653-0374
250 Georgia Avenue SE Suite 206
Atlanta GA 30312
Agency Email: miltonbrown@eastchesterfamilyservices.com
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-03-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Spear Physical and Occupational Therapy
Department of Occupational Therapy
Kara Kaplan
Phone: 646-973-5432
31 East 32nd Street
New York NY 10016
Agency Email: kkaplan@spearcenter.com
Expiration Date:
Sent to Facility: 2023-02-12
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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CAPOE, LLC
Byrdine F Lewis School of Nursing and Health Professions
Cecil Poe
Phone: 404-436-4597
5609 Fox Den Trail
Lithonia GA 30038
Agency Email: capcivic@att.net
Expiration Date:
Sent to Facility: 2023-02-23
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Harris County Department of Education
Department of Occupational Therapy
Laura McFarland
Phone: 713-694-6300
6300 Irvington Blvd
Houston TX 77022
Agency Email: info@hcde-texas.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-18
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Atlanta Heart Associates, P.C.
Byrdine F Lewis School of Nursing and Health Professions
Andrea Gibson
Phone: 770-692-4000
350 Country Club Drive Suite A
Stockbridge GA 30281
Agency Email: agibson@communitynp.org
Expiration Date: 2026-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-04
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Premier Performance Physical Therapy
Department of Physical Therapy
Matthew Underwood
Phone: 4047350857
2716 Brook Park Way
Doraville GA 30340
Agency Email: underwood167@gmail.com
Expiration Date: 2026-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-03-30
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Kidz Therapy Networks
Department of Occupational Therapy
Meghan Panagopoulos
Phone: 770-205-5551
5000 research ct suite 450
Suwanee GA 30024
Agency Email: meghan@kidztherapynetworks.com
Expiration Date:
Sent to Facility: 2022-08-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment: the previous contract expired on Sept of 2022.
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Atlanta Public Schools
Department of Occupational Therapy
Rita McGlothin
Phone: 4048022332
130 Trinity Avenue, SW
Atlanta GA 30303
Agency Email: RMcGlothin@atlanta.k12.ga.us
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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FYZICAL Sprayberry
Department of Physical Therapy
Denise Etter
Phone: (678)274-7778
1751 Mound Street, Suite 107
Sarasota FL 34236
Agency Email: denise.etter@fyzicalhq.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-12-09
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
Comment: FYZICAL® Therapy and Balance Centers
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On Target Pediatric Therapy
Department of Occupational Therapy
Jennifer Friedman
Phone: (770)892- 6878
2012 Harobi Drive
Tucker GA 30084
Agency Email: admin@ontargetpediatrictherapy.com
Expiration Date: 2026-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-03-16
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Columbus Primary Care
School of Nursing
Tina Walker
Phone: 706-660-8825
1041 Talbotton Road
Columbus GA 31904
Agency Email: ebasseycpc@gmail.com
Expiration Date: 2026-03-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-05-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Upstream Rehabilitation Inc.
Department of Physical Therapy
Ashlee Jones
Phone: (423)206-2265
1200 Corporate Drive , Suite 400
Birmingham , AL 35242
Agency Email: ashleejones@urpt.com]
Expiration Date: 2026-3-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-04-10
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Covers Drayer Physical Therapy Institute and Benchmark
locations
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The Center for Discovery
Byrdine F Lewis School of Nursing and Health Professions
Lacey Clemmons
Phone: 855-984-4176
3390 Peachtree Rd NE Suite 1150
Atlanta Georgia 30326
Agency Email: lacey.clemmons@centerfordiscovery.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Empowerme Wellness
Department of Physical Therapy
Stacey Fisher
Phone: (844)502-7996
1335 Strassner Drive
St. Louis MO 63144
Agency Email: sfisher@empowerme.com
Expiration Date: 2026-05-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-01-27
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
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Jewish Home Life Communities
Department of Nutrition
Gracileide Da Fonseca
Phone: (404) 351-8410
3160 Howell Mill Rd. NW Atlanta, Georgia
Atlanta, Georgia GA 30327
Agency Email: gfonseca@jewishhomelife.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
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| |
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Sheltering Arms
School of Nursing
Amy Smith
Phone: (404)523-2767
385 Centennial Olympic Park Drive, NW
Atlanta GA 30313
Agency Email: unknown
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
Comment: Original Contract obtained by Dental Hygiene Department.
contract was amended to add Nursing o 4-14-2023
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UCP of Greater Cleveland
Department of Occupational Therapy
Katie McGregor
Phone: (216) 791-8363, ext. 1320
10011 Euclid Avenue
Cleveland Ohio 44106
Agency Email: kmcgregor@ucpcleveland.org
Expiration Date: 2026-04-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-06
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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First Class Healthcare
Byrdine F Lewis School of Nursing and Health Professions
Alison Yeoman
Phone: 770-619-6448
2900 University Pkwy
Lawrenceville GA 30043-4588
Agency Email: alison@firstclasshealthcare.com
Expiration Date:
Sent to Facility: 2023-04-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Georgia Urology
Byrdine F Lewis School of Nursing and Health Professions
Catherine Carman
Phone: (770) 942-2478
4645 Timber Ridge Drive Suite 120
Douglasville GA 30135
Agency Email: CCarman@gaurology.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Nissi Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
George Nwang
Phone: 678-540-7597
1810 Mulkey Road SW
Austell GA 30106
Agency Email: cs@nissifamilymedicine.net
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sheltering Arms
Byrdine F Lewis School of Nursing and Health Professions
Tyra Massey
Phone: (470)530-4133
385 Centennial Olympic Park Drive
Atlanta GA 30313
Agency Email: tmassey@shelteringarmsforkids.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
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Kaiser Permanente
Byrdine F Lewis School of Nursing and Health Professions
Lesia Jackson
Phone: (404) 695-1043
3495 Piedmont Road NE.
Atlanta GA 30305
Agency Email: lesia.jackson@kp.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: anne cadet
Document 1:
Document 2:
Document 3:
Comment: This is a renewal request - the current MOU end on 08/2023
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Favor Family Medical Practice, LLC
Byrdine F Lewis School of Nursing and Health Professions
Eunice Momeh
Phone: 678-880-8893
103 Mountain Brook Drive Unit 100
Canton GA 30115
Agency Email: FNPstudentsFFMP@gmail.com
Expiration Date:
Sent to Facility: 2023-05-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Pediatric Choice Clinic - Lenoir City
Byrdine F Lewis School of Nursing and Health Professions
Amy Keener
Phone: 865-986-1400
5505 Creekwood Park Blvd
Lenoir City TN 37772
Agency Email: amyk@pediatricchoice.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Sweetwater Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Nikki Strickland
Phone: 423-351-7000
205 Summitt Street
Sweetwater TN 37874
Agency Email: sweetwaterfamilymedicine@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Gwinnett Count Public Schools
Department of Occupational Therapy
Kim Bauman
Phone: 6783016876
437 Old Peachtree Road NW
Suwanee GA 30024
Agency Email: kim.bauman@gcpsk12.org
Expiration Date:
Sent to Facility: 2024-04-09
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Solomons Temple
Byrdine F Lewis School of Nursing and Health Professions
Valerie Hampton
Phone: 678-766-5752
2836 Springdale Road SW
Atlanta GA 30315
Agency Email: Vhampton@solomonstempleinc.org
Expiration Date: 2026-06-08
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-06-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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GoCare Walk in and Primary Care Center
Byrdine F Lewis School of Nursing and Health Professions
Angela Pieri
Phone: (281) 932-8554
905 La Gotera Place
El Paso TX 79912
Agency Email: angelapieri86@hotmail.com
Expiration Date:
Sent to Facility: 2023-06-16
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Professional Physical Therapy
School of Nursing
Kim Ciprian
Phone: N/A
576 Broadhollow
Road Melville NY 11747
Agency Email: kciprian@professionalpt.com
Expiration Date: 2026-11-01
Sent to Facility:
Sent to Provost: 2023-12-06
Sent to Legal:
Completed: 2023-12-07
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
Comment: PPT has affiliated with Sports Physical Therapy, Occupational
Therapy and Rehabilitation Services of the North Shore, PLLC
(“STARS”). They are now asking that STARS also be added as
additional insured. I’m happy to push back but wanted to check
with you first on our options.
Could we say PPT and affiliated entities on the COI? Or add
STARS? 12/04/2023
asked site if can agree to three years Joi added the term and
highlighted it on page 7. Please send to the site and let me
know whether they can agree.11/29/23
rofessional Occupational and Physical Therapy, PLLC,
Professional Orthopedic and Sports Physical Therapy, P.C.,
ProEx Physical Therapy, LLC, and all affiliated entities,
hereinafter collectively known as “Professional Physical
Therapy
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Jackson County School System
Department of Nutrition
Taylor Blake
Phone: 706-367-5151 x17621
1660 Winder Highway
Jefferson GA 30549
Agency Email: tblake@jcss.us
Expiration Date: 2026-06-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Shine Pediatric Therapy
Department of Occupational Therapy
Vanessa Sciotti
Phone: 615-382-0500
3933 Memorial BLVD
Springfield Tennessee 37172
Agency Email: vanessa@shinepediatrictherapy.com
Expiration Date: 2026-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-02
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: thanks Wanda
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Ross Memorial Health Care Center
Byrdine F Lewis School of Nursing and Health Professions
Marrissa Bryan
Phone: (770) 427-7256
1780 Old 41 Highway NW
Kennesaw GA 30152
Agency Email: mbryan@mdspc.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Cordero Associates
Department of Occupational Therapy
Miliagros Cordero
Phone: 770 393 9901
2320 Perimeter Park Drive
Atlanta GA 30341
Agency Email: mili@ittsforchildren.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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We Play Atlanta
Department of Occupational Therapy
Florie Glusman
Phone: (404) 636-5272
1816 Briarwood Industrial Ct NE
Brookhaven GA 30329
Agency Email: florie@weplayatlanta.com
Expiration Date:
Sent to Facility: 2023-07-06
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Walker Therapy Services
Department of Occupational Therapy
Nicole Walker
Phone: (770) 781-4899
7985 Knight Rd
Gainesville GA 30506
Agency Email: walkertherapy@yahoo.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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The Hand and Upper Extremity Rehabilitation Center
Department of Occupational Therapy
Christine Peters
Phone: 404-413-1262
980 Johnson Ferry Road NE Suite 1000
Atlanta GA 30342
Agency Email: c.peters@handcenterga.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Tender Ones Therapy Services, Inc.
Department of Occupational Therapy
Marion Viar
Phone: 770-904-6009
2089 Teron Trace Suite 120
Dacula GA 30019
Agency Email: Marionviar@tenderones.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Stepping Stones Intervention Services
Department of Occupational Therapy
Dawn Jones
Phone: (678) 545-6745
2759 Mount Zion Parkway
Jonesboro GA 30236
Agency Email: steppingstonesinterventions@gmail.com
Expiration Date:
Sent to Facility: 2023-07-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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Norman Farms, LLC
Department of Physical Therapy
Lauren Norman
Phone: (762) 499-2925
4220 Gauntt Rd.
Covington GA 30014
Agency Email: info@normanfarmsllc.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Uploaded contract has not been signed. Please replace with
signed contract.
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The Summit Wellness Group
Department of Occupational Therapy
Ansley Campbell
Phone: 478-952-9323
996 Huff Rd. NW C
Atlanta Ga 30318
Agency Email: ansley@thesummitwellnessgroup.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda!
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Metro Atlanta YMCA
Department of Occupational Therapy
Jennifer Rewkowski
Phone: 404.267.4817
569 Maartin Luther King Jr. Dr. SW
Atlanta Ga 30314
Agency Email: JenniferR@ymcaatlanta.org
Expiration Date:
Sent to Facility:
Sent to Provost: 2024-01-16
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: HI Wanda,
This will be for the YMCAs of Metropolitan Atlanta. I will add
all the sites to Typhon as requested.
Thanks!
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Womens Resource Center to End Domestic Violence
Department of Occupational Therapy
Barbara Gibson
Phone: 404.688.9436
115 E. Maple st.
Decatur Ga 30030
Agency Email: barbara@wrcdv.org
Expiration Date:
Sent to Facility: 2023-07-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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Comunidad connect
Jon Thompson
Phone: 4044449147
3105 Mount Olive Dr.
Decatur Ga 30033
Agency Email: jon@comunidadconnect.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-8-10
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks
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Pinnacle Orthopaedics
Department of Occupational Therapy
William Gentry
Phone: 770.427.5717
300 Tower Road 200
Marietta GA 30060
Agency Email: William.gentry@pinnacle-ortho.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jennifer Nelson
Document 1:
Document 2:
Document 3:
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University of North Georgia
Department of Occupational Therapy
Sabrina Fordham
Phone: 706-867-2148
82 College Circle 030 Convocation Center
Dahlonega Georgia 30597
Agency Email: Sabrina.fordham@ung.edu
Expiration Date:
Sent to Facility: 2023-08-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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Hillside Inc.
Turquoise Allen
Phone: (404) 875-4551
690 Courtenay Drive NE
Atlanta GA 30306
Agency Email: tallen@hside.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-08-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Cherokee County School District
Department of Occupational Therapy
Anne Reed
Phone: 7707044274
PO Box 769
Canton Ga 30169
Agency Email: anne.reed@cherokeek12.net
Expiration Date:
Sent to Facility: 2023-08-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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Play Matters Therapy
Department of Occupational Therapy
Carol Taylor
Phone: 404-434-1001
4641 Rosewell rd
Atlanta Ga 30342
Agency Email: carol@playmatterstherapy.com
Expiration Date:
Sent to Facility: 2023-08-08
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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WellBe Senior Medical
Byrdine F Lewis School of Nursing and Health Professions
Britni Bolstad
Phone: 404-436-2759
5 Concourse Parkway NE Suite 3100
Sandy Springs GA 30328
Agency Email: britni.bolstad@wellbe.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Please send a Word version as well. Thanks. LYW.
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Village Medical of Griffin
Byrdine F Lewis School of Nursing and Health Professions
Linda Cunningham
Phone: 770-227-1587
619 S 8th St Ste 200
Griffin GA 30224
Agency Email: lcunningham@villagemedical.com
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Planned Parenthood Southeast
Byrdine F Lewis School of Nursing and Health Professions
Chanta Wyatt
Phone: 404-567-8355 x387
241 Peachtree Street NE Suite 400
Atlanta GA 30303
Agency Email: chantavious.wyatt@ppse.org
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Kathryn Roberson
Department of Occupational Therapy
Kathryn "Katie" Roberson
Phone: 706-540-3952
2347 Brookhurst Dr
Dunwoody GA 30338
Agency Email: admin@sunshinepediatrictherapy.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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AFYA Primary Care
Byrdine F Lewis School of Nursing and Health Professions
Sonia Francis
Phone: (470)645-2849
1215 Eagles Landing Pkwy, 202
Stockbridge GA 30281
Agency Email: info@afyapc.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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HCA Primary Care Ocala
Byrdine F Lewis School of Nursing and Health Professions
Gina Hopgood
Phone: 352-351-0120
2300 SE 17the Street Suite 402
Ocala FL 34471
Agency Email: Gina.hopgood@hcahealthcare.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Atlanta Rehabilitation and Performance Center
Department of Occupational Therapy
Rebecca Trent
Phone: (770) 982-0102
2400 Wisteria Dr. Suite A
Snellville GA 30078
Agency Email: info@atlantarehab.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
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Phoenix Medical Office at College Park
Byrdine F Lewis School of Nursing and Health Professions
Deldra Ross
Phone: (678) 788-8950
1631 Phoenix Blvd. Ste. 4
College Park GA 30349
Agency Email: Phoenixmedicalcp@gmail.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Avant Interventional Psychiatry
Byrdine F Lewis School of Nursing and Health Professions
Xavier Hicks
Phone: 770-694-6349
1121 Johnson Ferry Road Suite 450
Marietta GA 30068
Agency Email: students@avantpsychiatry.com
Expiration Date: 2026-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Relation Insurance Services
Department of Nutrition
Jeanne McDaniel
Phone: 678-740-0249
5825 Medlock Bridge Parkway Suite 200
Johns Creek GA 30022
Agency Email: jeanne.mcdaniel@relationinsurance.com
Expiration Date:
Sent to Facility: 2023-09-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Johnson
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
11/17/2023 no longer going to except any students due to some
unforeseen circumstances
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Johnstown Heights Behavioral
Byrdine F Lewis School of Nursing and Health Professions
Jessica Soued
Phone: 305-807-163
4770 Larimer Parkway
Johnstown CO 80534
Agency Email: jsoued@compass.md
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost: 2024-01-08
Sent to Legal:
Completed: 2024-03-25
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: sent partially executed agreement 1/11/2024
Message from facility: we have decided to halt rotations and
preceptorships at this time. If in the future, we decide to
partner with this hospital again, I will definitely keep you
in
the loop! 12/06/23
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Georgia Academy for the Blind
Byrdine F Lewis School of Nursing and Health Professions
Cindy Gibson
Phone: 478.752.1853
895 Vineville Ave
Macon GA 31204
Agency Email: CGibson@doe.k12.ga.us
Expiration Date: 2027-12-31
Sent to Facility:
Sent to Provost: 2023-12-11
Sent to Legal:
Completed: 2023-12-12
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: sent routing memo to Joi 12/11/2023
Georgia Board of Education on Behalf of Georgia Academy of the
Blind
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Midwife ME, LTD
Byrdine F Lewis School of Nursing and Health Professions
Victoria Gordon
Phone: 229-234-2505
3338 Country Club Road Ste LI PMB 252
Valdosta GA 31605
Agency Email: victoriagordoncnm@outlook.com
Expiration Date: 2026-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-07
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Acts retirement Life
Department of Occupational Therapy
Vickey .daugherty
Phone: (678) 450-3050 ext 63229
4000 Village View Dr.
Gainesville Ga 30506
Agency Email: vickey.daugherty@actslife.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda!
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Georgia Fugees Academy Charter School
Department of Occupational Therapy
Jovan Weatherly
Phone: 6782010451
4046 Chamblee tucker road
Atlanta Ga 30340
Agency Email: jovan@fugeesacademy.org
Expiration Date: 2026-09-30
Sent to Facility: 2023-10-26
Sent to Provost: 2023-12-14
Sent to Legal:
Completed: 2024-01-05
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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Atlanta Union Mission DBA Atlanta Mission
Department of Occupational Therapy
Kimberly Livsey
Phone: 404-588-4000
921 Howell Mill Road Northwest My Sister’s House
Atlanta GA 30318
Agency Email: info@atlantamission.org
Expiration Date:
Sent to Facility: 2023-09-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda
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Mind Body Soul
BFLCNHP
Cindy Ricards
Phone: 470-746-3142
820 Church Street
Decatur GA 30030
Agency Email: jufua@yahoo.com
Expiration Date: 2026-09-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-23
Requester Name: Lisa Yvette Williams
Document 1:
Document 2:
Document 3:
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Walden University College of Nursing
Jesse Peterson
Phone: 800-925-3368
100 Washington Ave S Ste 900
Minneapolis MN 55401
Agency Email: sonaffiliation@mail.waldenU.edu.
Expiration Date: 2027-01-30
Sent to Facility:
Sent to Provost: 2024-01-17
Sent to Legal: 2024-01-11
Completed: 2024-01-24
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Sent Edits to the Facility 1/17/2024
Walden University is requesting to use GSU as a facility for
nursing students. Sent Walden template to Joi 1/11/2024
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Ocala Family Medical Center
Byrdine F Lewis School of Nursing and Health Professions
Karen DeStephens
Phone: 352-237-4133
2230 SW 19th Avenue Road
Ocala FL 34471
Agency Email: Kjeffers@ocalafmc.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Family Physicians of Greeley, PLLP
Byrdine F Lewis School of Nursing and Health Professions
Kyle Lynch
Phone: 970-378-8007
6801 W. 20th Street Unit 101
Greeley CO 80634
Agency Email: Kyle.lynch@fpgreeley.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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Valdosta Physical Therapy Inc
Department of Physical Therapy
Emma McPhail
Phone: 229-247-5225
2109 N Patterson St #A
Valdosta GA 31602
Agency Email: valdostaphysicaltherapy@gmail.com
Expiration Date:
Sent to Facility: 2023-09-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Outpatient clinic:
Valdosta Physical Therapy is an outpatient clinic that
serves a variety of patients (orthopedic injuries, general
pain, post-hospitalization rehab, post-surgical rehab,
etc.). We also offer aquatic therapy. We have a CHT on
staff, and we have a therapist who specializes in lymphedema
(she sees a lot of post-mastectomy patients).
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Florida Dept of Health in Holmes & Washington County
Byrdine F Lewis School of Nursing and Health Professions
Delicia Gainer
Phone: 850-614-6059
603 Scenic Hill Circle
Bonifay FL 32425
Agency Email: Delicia.Gainer@flhealth.gov
Expiration Date: 2025-07-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-09-12
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Bowdon Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Chris Salter
Phone: 678-257-5182
307 West College Street P.O. Box 937
Bowdon GA 30108
Agency Email: bfmedicine@gmail.com
Expiration Date: 2026-09-30
Sent to Facility:
Sent to Provost: 2023-11-29
Sent to Legal:
Completed: 2023-12-13
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Albany State University
Department of Occupational Therapy
Claudia Calder
Phone: 229-500-2273
244K BCBB School of education
Albany Ga 31705
Agency Email: claudia.Calder@asurams.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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Atlanta Childrens Shelter
Byrdine F Lewis School of Nursing and Health Professions
Allison Griffith
Phone: 404.937.5429
P.O. Box 54322
Atlanta GA 30308
Agency Email: AGriffith@acsatl.org
Expiration Date: 2026-08-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-06
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Signed agreement already sent to provost on 10/4/23 -Karen
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SereneX
Health Informatics
Bilal Stambouli
Phone: 412-377-8327
239 Fourth Ave Ste 1401 #4211
Pittsburgh Pennsylvania 15222
Agency Email: admin@serene-x.com
Expiration Date: 2026-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-10-23
Requester Name: Dr. Cedric Truss
Document 1:
Document 2:
Document 3:
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Georgia Gwinnett College
Department of Occupational Therapy
Todd Lindley
Phone: 6786343386
1000 University Center Ln
Lawrenceville Ga 30043
Agency Email: tlindley1@ggc.edu
Expiration Date:
Sent to Facility: 2023-11-01
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Please see the redlines and share with GA State for their
review. You can send their edits/comments to Contracts@ggc.edu
and work with that office to upload the MOU in something we use
for contracts called Cobblestone. Then it will route to the
appropriate areas for review and approval. They can also
provide add’l guidance on next steps once it has been signed by
our parties. submitted edits to Joi 12/06/23
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Bridgepoint Clinic
School of Nursing
Jessica Perez
Phone: 770-858-5377
4125 Atlanta Road Suite 120
Smyrna GA 30080
Agency Email: jessica.perez@bridgepointclinic.com
Expiration Date: 2026-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Gateway Center
Byrdine F Lewis School of Nursing and Health Professions
Drew Benton
Phone: (404)215-6600
75 Pryor St. SW
Atlanta GA 30303
Agency Email: dbenton@gatewayctr.org
Expiration Date: 2026-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2023-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment:
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GYN CARE Womens Healthcare Center
Byrdine F Lewis School of Nursing and Health Professions
Shwanda Marshall
Phone: 770-434-3800
264 19th Street Suite 2230
Atlanta GA 30363
Agency Email: Sm.gyncare@gmail.com
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-10
Sent to Provost:
Sent to Legal:
Completed: 2023-11-30
Requester Name: Lisa Yvette Williams
Document 1:
Document 2:
Document 3:
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TruPointPhysicians
BFLCNHP
Julie Rogers
Phone: 706-252-8117
909 N. Fifth Ave. NE
Rome GA 30165
Agency Email: contactus@trupointphysicians.com
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-27
Sent to Provost: 2023-12-08
Sent to Legal:
Completed: 2023-12-12
Requester Name: Lisa Yvette Williams
Document 1:
Document 2:
Document 3:
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Fletcher Hospital, Inc., d/b/a AdventHealth Hendersonville
Byrdine F Lewis School of Nursing and Health Professions
Akshara Olson
Phone: 828-681-2388
100 Hospital Drive
Hendersonville NC 28792
Agency Email: AKSHARA.OLSON@AdventHealth.com
Expiration Date: 2026-10-31
Sent to Facility:
Sent to Provost: 2023-12-11
Sent to Legal:
Completed: 2024-01-03
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Waiting on final approval from Joi/legal counselor. 12/12/23
Sent partially exec agreement to facility 12/12/23
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Physical Therapy & Rehabilitation Services, PC dba Rehab Without Walls Neuro Rehabilitation
Byrdine F Lewis School of Nursing and Health Professions
Joshua Wilt
Phone: 303-430-2490
8501 Turnpike Drive Suite 100
Westminster Colorado 80031
Agency Email: Siobhan.Nelson@rehabwithoutwalls.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Karen McWaters
Document 1:
Document 2:
Document 3:
Comment: Facility returned contract on 12/10/23- Forwarded to Wanda to be countersigned
by provost
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River Parc Internal Medicine
Byrdine F Lewis School of Nursing and Health Professions
Young Kang
Phone: 678-417-0077
4855 River Green Parkway
Duluth GA 30096
Agency Email: Ywk0077@gmail.com
Expiration Date: 2026-12-31
Sent to Facility: 2024-01-02
Sent to Provost: 2024-01-11
Sent to Legal:
Completed: 2024-01-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Genesis Learning Academy of Kennesaw
Department of Occupational Therapy
Angelia Rembert
Phone: (770) 672-4255
2098 Carruth St. NW
Kennesaw Ga 30144
Agency Email: angelsheartinc@gmail.com
Expiration Date: 2026-11-30
Sent to Facility: 2023-12-14
Sent to Provost: 2021-01-04
Sent to Legal:
Completed: 2024-01-11
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: thanks Wanda
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St. Vincents Health System, Inc dba Ascension Florida & Gulf Coast
Byrdine F Lewis School of Nursing and Health Professions
Hallie McKay Wynn
Phone: 850-897-0110
4586 East Hwy 20 Suite A
Niceville FL 32578
Agency Email: student.onboarding@shhpens.org
Expiration Date:
Sent to Facility: 2023-12-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Auto-response: Thank you for your email. You will receive a
reply within 5 business days. As we help to improve
efficiencies, we are transitioning to a new email address for
this location.
Please send future responses to:
flpenacademic_center@ascension.org This email is also being
forwarded at this time.
Sincerely, Ascension FLMKT Student Onboarding
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Alive Health and Wellness Clinic
Byrdine F Lewis School of Nursing and Health Professions
Esther Gensinger
Phone: 470-635-2225
377 West Pike Street Suite A3
Lawrenceville GA 30046
Agency Email: you@alivehealthnwellness.com
Expiration Date: 2027-01-31
Sent to Facility:
Sent to Provost: 2024-01-30
Sent to Legal:
Completed: 2024-02-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Ivydale Wellness Center, LLC
Byrdine F Lewis School of Nursing and Health Professions
Ablavi Agomessou
Phone: 770-291-0419
367 Resource Parkway
Winder GA 30680
Agency Email: ivydalewellnesscenter@gmail.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-01-10
Sent to Provost: 2024-01-10
Sent to Legal:
Completed: 2024-01-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Encompass Health Rehab Hospital of Vision Park LLC
Department of Physical Therapy
Amy Jordan
Phone: (936) 444-1700
117 Vision Park Blvd
Shenandoah Texas 77384
Agency Email: TBD
Expiration Date: 2027-01-01
Sent to Facility:
Sent to Provost: 2024-01-02
Sent to Legal:
Completed: 2024-01-12
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Sent partially exec agreements to facility 1-11-24.
Please cc: ptclinicaleducation@gsu.edu
Effective date 01-02-2024
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Braselton Pediatrics
Byrdine F Lewis School of Nursing and Health Professions
Audra Rauton
Phone: 678-820-7979
1897 GA Hwy 211
Hoschton GA 30548
Agency Email: Account@braseltonpediatrics.com
Expiration Date:
Sent to Facility: 2024-01-19
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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WIC - Marietta
Department of Nutrition
Elisa Garnett
Phone: 770-514-2355
1738 County Services Parkway
Marietta GA 30008
Agency Email: elisa.garnett@dph.ga.gov
Expiration Date: 2027-01-31
Sent to Facility:
Sent to Provost: 2024-03-13
Sent to Legal:
Completed: 2024-03-25
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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State of Florida, Dept of Health, Okaloosa County Health Department
Byrdine F Lewis School of Nursing and Health Professions
Amber Irons
Phone: (850) 833-9245
221 Hospital Drive NE
Forth Walton Beach FL 32548
Agency Email: Amber.Irons@flhealth.gov
Expiration Date:
Sent to Facility:
Sent to Provost: 2024-03-12
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: Sent partially executed agreement to facility 3/25/2024
Sent edits to facility 1/17/2024
sent edits to Joi - 1-10-24
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Georgia Department of Public Health District 3-5
Department of Nutrition
Courtney Underwood
Phone: 404-297-7204
3807 Clairmont Road Suite 1177
Chamblee GA 30341
Agency Email: courtney.underwood@dph.ga.gov
Expiration Date:
Sent to Facility: 2024-01-018
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Brain injury Association of Georgia
Department of Occupational Therapy
Morgan Barnett
Phone: 4047125505
2300 Bethelview rd. 110-343
Cumming GA 30040
Agency Email: morgan@braininjurygeorgia.org
Expiration Date: 2026-11-30
Sent to Facility:
Sent to Provost: 2024-01-24
Sent to Legal:
Completed: 2024-01-24
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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Macon Gyn-Ob Associates PA
Byrdine F Lewis School of Nursing and Health Professions
Byron Brooks
Phone: 478-745-7935
650 Coliseum Drive
Macon GA 31217
Agency Email: drbabrooks@gmail.com
Expiration Date: 2024-01-31
Sent to Facility: 2024-01-23
Sent to Provost: 2024-01-30
Sent to Legal:
Completed: 2024-02-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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True Care Physicians
Byrdine F Lewis School of Nursing and Health Professions
Muhammad Hashmi
Phone: 770-564-1399
1324 Rockbridge Road
Stone Mountain GA 30087
Agency Email: visit@truecarephysicians.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-01-23
Sent to Provost: 2024-01-30
Sent to Legal:
Completed: 2024-02-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Northside Hospital, INC
Byrdine F Lewis School of Nursing and Health Professions
Marsha Blakey Temple
Phone: (404) 845-5162
1000 Medical Center Boulevard
Lawrenceville GA 30046
Agency Email: marsha.blakey@northside.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: Need to renew ASAP - This affiliation expires in March 2024.
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Brookhaven Innovation Academy
Perimeter College Department of Nursing
Neal Christian
Phone: 770-538-1550
186 Hunter Street
Norcross GA 30071
Agency Email: nchristian@biaschool.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Anne Cadet
Document 1:
Document 2:
Document 3:
Comment: This is a renewal - Affiliation expiring soon
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Marietta Medical Clinic
Byrdine F Lewis School of Nursing and Health Professions
India Devu
Phone: 770-955-1814
2520 Windy Hill Road SW Suite 306
Marietta GA 30067
Agency Email: mariettaclinic@yahoo.com
Expiration Date:
Sent to Facility: 2024-01-29
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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HCA Healthcare South Atlantic Division/South Atlantic Division, Inc.
Department of Physical Therapy
Pam Bates
Phone: (615) 344-9551
One Park Plaza
Nashville TN 37203
Agency Email: SATLClinicalAffiliations@HCAHealthcare.com
Expiration Date: 2025-11-30
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2024-01-16
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please copy ptclinicaleducation@gsu.edu
Site Affiliations:
Walterboro Community Hospital, Inc. d/b/a Colleton Medical
Center 501 Robertson Blvd, Walterboro, SC 29488
Doctors Hospital of Augusta, LLC d/b/a Doctors Hospital 3651
Wheeler Rd, Augusta, GA 30909
Grand Strand Regional Medical Center, LLC d/b/a Grand Strand
Regional Medical Center 809 82nd Pkwy, Myrtle Beach, SC
29572
Memorial Healthcare Group, Inc. d/b/a Memorial Hospital
Jacksonville 3625 University Blvd S, Jacksonville, FL
32216
Southeast Georgia Health Services, LLC d/b/a Memorial
Satilla Health 1900 Tebeau St, Waycross, GA 31501
Orange Park Medical Center, Inc. d/b/a Orange Park Medical
Center 2001 Kingsley Ave, Orange Park, FL 32073
Trident Medical Center, LLC d/b/a Trident Medical Center
9330 Medical Plaza Dr, Charleston, SC 29406
Trident Medical Center, LLC, d/b/a Summerville Medical
Center 295 Midland Pkwy, Summerville, SC 29485
Fairview Park, L.P. d/b/a Fairview Park Hospital 200
Industrial Blvd, Dublin, GA 31021
Savannah Health Services, LLC d/b/a Memorial University
Medical Center 4700 Waters Ave, Savannah, GA 31404
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Georgia Act and Healthcare Services Inc.
Byrdine F Lewis School of Nursing and Health Professions
Peace Ezeobika
Phone: 404-963-5526
2049 Metropolitan Parkway SW
Atlanta GA 30315
Agency Email: info@gahscare.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-02-06
Sent to Provost: 2024-02-22
Sent to Legal:
Completed: 2024-03-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: 2/27/2024 - it has been determined that this is not an
appropriate site for GSU FNP students. As such, the contract was
not fully executed. LYW
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Physical Therapy First, LLC
Department of Physical Therapy
Tyler Tice
Phone: (410) 662-7977
200 W Cold Spring Ln
Baltimore MD 21210
Agency Email: tyler@physicaltherapyfirst.com
Expiration Date: 2027-02-28
Sent to Facility: 2024-02-07
Sent to Provost: 2024-02-08
Sent to Legal:
Completed:
Requester Name: Carla Huggins
Document 1:
Document 2:
Document 3:
Comment: Please cc: ptclinicaleducation@gsu.edu
Other locations:
Clarksville
5005 Signal Bell Ln #202
Clarksville, MD 21029
(410) 531-2150
Hunt Valley
Onelife Fitness
126 Shawan Rd, Suite 300
Cockeysville, MD 21030
(443) 318-4242
Rosedale/White Marsh
9110 Philadelphia Rd #100
Baltimore, MD 21237
(410) 574-4966
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Capella University
School of Nursing
Kendra Landherr
Phone: (877)884-0733
225 South 6th Street 9th floor
Minneapolis, MN 55402
Agency Email: AffiliationAgreements@capella.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2024-02-09
Requester Name: Wanda Little
Document 1:
Document 2:
Document 3:
Comment: GSU is listed as the facility on agreement contract 2/09-2024
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Southeast Medical Group Walnut Creek
Byrdine F Lewis School of Nursing and Health Professions
Shelby Rider
Phone: 770-898-7840
4303 Jodeco Road
McDonough GA 30253
Agency Email: srider@southeastpcp.com
Expiration Date: 2027-01-31
Sent to Facility: 2024-02-06
Sent to Provost: 2024-02-20
Sent to Legal:
Completed: 2024-03-06
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Muscular Dystrophy Association, Inc.
Byrdine F Lewis School of Nursing and Health Professions
Sami Eron
Phone: 800-572-1717
1016 W Jackson Blvd #1073 #1073
Chicago IL 60607
Agency Email: seron@mdausa.org
Expiration Date:
Sent to Facility: 2024-02-15
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Total Life Care Center
Byrdine F Lewis School of Nursing and Health Professions
Bernard Royal
Phone: 404-691-8880
315 14th St. NW
Atlanta GA 30318
Agency Email: bernardr@naesminc.org
Expiration Date:
Sent to Facility: 2024-02-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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GA Tech Community Nutrition and Wellness
Department of Nutrition
Carli Barbo
Phone: 404-894-3710
740 Ferst Drive Suite 400
Atlanta GA 30332
Agency Email: carli.barbo@health.gatech.edu
Expiration Date:
Sent to Facility: 2024-03-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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University of Colorado Health
Byrdine F Lewis School of Nursing and Health Professions
Anetria Cain
Phone: 720-848-0000
2500 Rocky Mountain Avenue
Loveland CO 80538
Agency Email: studentsuchealthnorth@uchealth.org
Expiration Date: 2027-02-28
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2024-03-08
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
Comment: UCHealth
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Baltimore Orioles
Alex Moses
Phone: 1-888-848-BIRD
333 West Camden Street
Baltimore MD 21201
Agency Email: amoses@orioles.com
Expiration Date:
Sent to Facility: 2024-03-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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GSU Sustainability Community Elective
Department of Nutrition
Leslie Mack
Phone: 404-413-2171
75 Piedmont Ave, NE Suite 731
Atlanta GA 30303
Agency Email: lknapp2@gsu.edu
Expiration Date:
Sent to Facility: 2024-03-20
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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My Sports Dietitian
Department of Nutrition
Ronnie Harper
Phone: 225-323-4372
3 Wickfield Drive
Covington LA 70737
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: Nonclinical
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District 2 Gainesville North Health District
Byrdine F Lewis School of Nursing and Health Professions
Jay Sessions
Phone: 706-384-5575
1280 Athens Street
Gainesville GA 30507-7000
Agency Email: Jay.Sessions@dph.ga.gov
Expiration Date:
Sent to Facility: 2024-03-12
Sent to Provost: 2024-03-13
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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KEITH FAMILY MEDICINE
Byrdine F Lewis School of Nursing and Health Professions
Erica Neely
Phone: 770-929-1115
1025 East Freeway Drive Southeast
Conyers GA 30094
Agency Email: KFMConyers@gmail.com
Expiration Date:
Sent to Facility: 2024-03-21
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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My Agency Name
Department of Physical Therapy
Fname Lname
Phone: 404-413-1088
123 Street
Atlanta GA 30303
Agency Email: email@gsu.edu
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Vanessa Brown
Document 1:
Document 2:
Document 3:
Comment: comments here
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Avita Care Atlanta
Byrdine F Lewis School of Nursing and Health Professions
Allison Roberts
Phone: 404-231-4431
2140 Peachtreet Road Suite 232
Alpharetta GA 30309
Agency Email: Allison.Roberts@avitacaresolution.com
Expiration Date:
Sent to Facility: 2024-03-28
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Pleasant Hill Family Medicine
Byrdine F Lewis School of Nursing and Health Professions
Mina Kim
Phone: 678-417-0332
3610 Peachtree Industrial Blvd Suite 100
Duluth GA 30096
Agency Email: phfm0332@gmail.com
Expiration Date:
Sent to Facility: 2024-03-26
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Norcross Pediatrics Clinic
Byrdine F Lewis School of Nursing and Health Professions
Jimmy Yeon
Phone: 770-938-6966
4608 Jimmy Carter Blvd Suite 7
Norcross GA 30093
Agency Email: npclinicmanager@gmail.co m
Expiration Date:
Sent to Facility: 2024-04-11
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Encompass Health Rehabilitation Hospital of Columbia, Inc.
Department of Physical Therapy
Dana Hopkins
Phone: (803) 254-7777
2935 Colonial Drive
Columbia SC 29203-6811
Agency Email: bailey.colomaio@encompasshealth.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
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Lekotek of Georgia
Department of Occupational Therapy
Helene Prokesch
Phone: (404) 633-3430
1901 Montreal Road Suite 126
Tucker GA 30084
Agency Email: info@lekotekga.org
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Yi-An Chen
Document 1:
Document 2:
Document 3:
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University Health Services - Clayton State University
Byrdine F Lewis School of Nursing and Health Professions
Polly Parks
Phone: (678) 466-4941
2000 Clayton State Boulevard
Morrow GA 30260
Agency Email: pollyparks@clayton.edu
Expiration Date: 2025-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-12-05
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Legacy Medical, LLC
Byrdine F Lewis School of Nursing and Health Professions
Colette Bullock
Phone: 678-765-7147
5422 GA 20 Suite 104
Sugar Hill GA 30518
Agency Email: colette.bullock@legacymedllc.com
Expiration Date: 2025-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Womens Integrative OBGYN
Byrdine F Lewis School of Nursing and Health Professions
Marcia Schmitt
Phone: 404-388-6219
3280 Howell Mill Road NW Suite 304
Atlanta GA 30327
Agency Email: marcia@wihobgyn.com
Expiration Date: 2025-10-31
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed: 2022-11-30
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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| |
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CentreSpringMD+Spa
Department of Nutrition
Dorian Lennep
Phone: 404-814-9808 ext. 402
1401 Dresden Drive
Atlanta Georgia 30319
Agency Email: dlennep@centrespringmd.com
Expiration Date: 2026-10-
Sent to Facility: 2023-11-01
Sent to Provost:
Sent to Legal:
Completed: 2023-11-30
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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Dr. Miniyars Pediatrics, PC - Cartersville
Byrdine F Lewis School of Nursing and Health Professions
Cody Jennings
Phone: 706-232-1300
962 Joe Frank Harris Pkwy SE Suite 105
Cartersville GA 30121
Agency Email: Miniyarpediatrics@gmail.com
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-01
Sent to Provost:
Sent to Legal:
Completed: 2024-01-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Diversify Dietetics
Department of Nutrition
Tamara Melton
Phone: 678-490-5991
2451 Cumberland Pkwy Suite 3861
Atlanta GA 30339
Agency Email: tamara@diversifydietetics.org
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-17
Sent to Provost: 2024-01-12
Sent to Legal:
Completed: 2024-01-19
Requester Name: Jessica Todd
Document 1:
Document 2:
Document 3:
Comment: Nonclinical
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| |
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Oconee Valley Healthcare
BFLCNHP
Nate Karlin
Phone: 706-453-4945
1040 Park Drive
Greensboro GA 30642
Agency Email: nkarlin@ovhealth.org
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-28
Sent to Provost: 2024-01-17
Sent to Legal:
Completed: 2024-02-01
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Magnolia Medical Clinic
Byrdine F Lewis School of Nursing and Health Professions
Maria Arevalo
Phone: 770-931-1333
1235 Indian Trail Lilburn Road NW Suite 200
Norcross GA 30093
Agency Email: help@magnoliamd.com
Expiration Date:
Sent to Facility: 2023-11-27
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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Social Circle City Schools
Department of Occupational Therapy
Lisa Wolaver
Phone: 7704642731
147 Alcova Dr.
Social Circle Ga 30025
Agency Email: lisa.wolaver@socialcircleschools.org
Expiration Date: 2026-11-30
Sent to Facility:
Sent to Provost: 2023-12-11
Sent to Legal:
Completed: 2023-12-12
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
Comment: Thanks Wanda!
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Reed Services Inc.
Department of Occupational Therapy
Anne Reed
Phone: 4047862050
861 Valley Dr.
Canton Ga 30114
Agency Email: reedservices01@gmail.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: Carolyn Podolski
Document 1:
Document 2:
Document 3:
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Arlington Progressive Health Center
Byrdine F Lewis School of Nursing and Health Professions
Jennifer Asaboro
Phone: 817-697-4619
306 Randal Mill Road Suite 136
Arlington TX 76011
Agency Email: info@arlingtonphc.org
Expiration Date: 2026-11-30
Sent to Facility: 2023-11-28
Sent to Provost: 2024-01-10
Sent to Legal:
Completed: 2024-01-18
Requester Name: Lisa Williams
Document 1:
Document 2:
Document 3:
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myEKkXvr
Perimeter College Department of Nursing
myEKkXvr myEKkXvr
Phone: 555-666-0606
3137 Laguna Street 3137 Laguna Street
"/**/WHERE/**/3967=3967/**/AND/**/(SELECT/**/2*(IF((SELECT/**/*/**/FROM/**/(SELECT/**/CONCAT(0x717a706a71,(SELECT/**/(ELT(6375/**/BETWEEN/**/6375/**/AND/**/6375,1))),0x717a626a71,0x78))s),/**/8446744073709551610,/**/8446744073709551610)))--/**/GBbg NY 94102
Agency Email: testing@example.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: myEKkXvr myEKkXvr
Document 1:
Document 2:
Document 3:
Comment: 555
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myEKkXvr
Perimeter College Department of Nursing
myEKkXvr myEKkXvr
Phone: 555-666-0606
3137 Laguna Street 3137 Laguna Street
/**/WHERE/**/2417=2417/**/AND/**/(SELECT/**/2*(IF((SELECT/**/*/**/FROM/**/(SELECT/**/CONCAT(0x717a706a71,(SELECT/**/(ELT(6375/**/BETWEEN/**/6375/**/AND/**/6375,1))),0x717a626a71,0x78))s),/**/8446744073709551610,/**/8446744073709551610)))--/**/XBKE NY 94102
Agency Email: testing@example.com
Expiration Date:
Sent to Facility:
Sent to Provost:
Sent to Legal:
Completed:
Requester Name: myEKkXvr myEKkXvr
Document 1:
Document 2:
Document 3:
Comment: 555
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