Albany Atlanta Macon 2810 Meredyth Drive 1100 Circle 75 Parkway 577 Mulberry Street Suite B Suite 1100 5th Floor, Suite 580 Albany, Georgia 31707 Atlanta, Georgia 30339 Macon, GA 31202 Main: 229-430-5829 Main: 678-556-2300 Main: 478-738-8540 Fax: 229-435-6953 Fax: 877-683-3155 Fax: 855-475-4401 Provider Solutions Department - Territory List Provider Solutions Contact/Fax Numbers Territories Team & Email Addresses Lanitra Perry Office: 678-556-2470 Manager East & North Regions Fax: 877-683-3155 Email: [email protected] East & North Regions Banks, Clarke , Elbert, Franklin, Habersham, Hall, Hart, Jackson, Madison, Nicole Keyser Office: 678-556-2307 Morgan, Oconee, Oglethorpe, Stephens & White Specialist Fax: 877-683-3155 Group Accounts: Longstreet Clinic, Northeast Georgia Physician’s North Regions Email: [email protected] Group, CAAP, Toccoa Clinic, South Carolina Catoosa, Chatooga, Dade, Dawson, Fannin, Floyd, Gilmer, Gordon, Lumpkin, Margie Smith Office: 706-844-3063 Murray, Polk, Rabun, Towns, Union, Walker & Whitfield Specialist Fax: 877-683-3155 North Carolina, Northeast Alabama & Tennessee North Region Email: [email protected] Group Accounts: HOA & Erlanger Burke, Columbia, Emanuel, Greene, Hancock, Jefferson, Jenkins, Lincoln, Office: 770-807-4544 Shikira Coley McDuffie, Putnam, Richmond, Taliaferro, Warren, Washington, Wilkes Fax: 877-683-3155 Specialist Group Accounts: Physician’s Practice Group Email: [email protected] East Region South Carolina Keive Dixon Office: 678-556-2308 Sr. Manager Atlanta Region Fax: 877-683-3155 Atlanta Region Email: [email protected] Lisa Bender Barrow, DeKalb, Newton & Walton Office: 478-278-1955 Specialist Group Accounts: DeKalb PHO, DeKalb Medical, Kids Health Firs Fax: 877-683-3155 Atlanta Region Email: [email protected] Kelli Austin Butts, Henry, Jasper, North Fulton & Rockdale Office: 678-767-9358 Specialist Group Accounts: Southern Crescent, Rockdale Physicians Group Fax: 877-683-3155 Atlanta Region Kaiser Permanente, HCA/Parallon Email: [email protected] Forsyth, Gwinnett Danielle Walton Group Accounts: Gwinnett Health Systems PHO, Walgreens, Office: 678-556-2459 Specialist Atlanta Gastro Associates, WellStreet Clinic, GA Clinic, Pediatrix, Fax: 877-683-3155 Atlanta Region Email: [email protected] IPA of Georgia, IMPACT Tottianna Thomas Carroll, Cobb, Douglas, Haralson & Paulding Office: 678-556-2300 Specialist Group Accounts: Tanner / Healthwest, Piedmont Physicians Group, Fax: 877-683-3155 Atlanta Region Shepherd Center Email: [email protected] Keive Dixon Bartow, Cherokee, Pickens & South Fulton Office: 678-556-2308 Sr. Manager Group Accounts: Morehouse, ENT of Georgia, Grady Health System, Emory, Fax: 877-683-3155 Atlanta Region Northside Professional Services, TCHN Email: [email protected] Montia Fleming Clayton, Coweta, Spalding & Fayette Office: 678-556-2479 Specialist Group Accounts: Northside Hospital, Piedmont Hospital, Spalding PHO, Fax: 877-683-3155 Southern Regional Hospital, Children’s Healthcare of Atlanta, Tenet Atlanta Region Email: [email protected] Revised: 03/01/2017 1 Albany Atlanta Macon 2810 Meredyth Drive 1100 Circle 75 Parkway 577 Mulberry Street Suite B Suite 1100 5th Floor, Suite 580 Albany, Georgia 31707 Atlanta, Georgia 30339 Macon, GA 31202 Main: 229-430-5829 Main: 678-556-2300 Main: 478-738-8540 Fax: 229-435-6953 Fax: 877-683-3155 Fax: 855-475-4401 Provider Solutions Department - Territory List Provider Solutions Contact/Fax Numbers Territories Team & Email Addresses Jeffrey West Central Region Office: 478-738-8542 Manager Group Accounts: Medical Center of Central Georgia, Fax: 855-475-4401 Central Region Central Georgia Health Network Email: [email protected] Baldwin, Bibb, Bleckley, Crisp, Dooly, Dodge, Houston, Johnson, Laurens, Office: 478-738-8542 Jeffrey West Macon, Peach, Pulaski, Telfair, Treutlen, Twiggs, Wheeler, Fax: 855-475-4401 Manager Wilcox & Wilkinson Email: [email protected] Central Region Group Accounts: Houston Healthcare, Eastman Pediatric Clinics, Primary Pediatrics of Macon & CGMCN Chattahoochee, Crawford, Harris, Heard, Jones, Lamar, Marion, Meriwether, Jennifer Morris Monroe, Muscogee, Pike, Talbot, Taylor, Troup & Upson, Office: 478-738-8550 Specialist Phenix City (AL), Smith Station (AL), Auburn (AL) Fax: 855-475-4401 Central Region Group Accounts: The Medical Center, Inc. (Columbus), Email: [email protected] West Georgia Medical Center, Children’s Clinic of Lagrange, Columbus Physician Associates (CPA) & MyHealth Brittney Mathis Southwest Region Office: 229-430-5851 Sr. Manager Group Accounts: Phoebe Physician Group, Phoebe Health Partners Fax: 229-435-6953 Southwest Region Email: [email protected] Baker, Calhoun, Clay, Colquitt, Dougherty, Early, Lee, Miller, Quitman, Randolph, Carol Jackson Schley, Stewart, Sumter, Terrell, Tift, Turner, Webster, Worth Office: 229-430-5829 Specialist Eufaula & Dothan (Alabama), Tallahassee (Florida) Fax: 229-435-6953 Southwest Region Group Accounts: Kids Care Clinic, Sumter Pediatrics, Children’s Medical Group, Email: [email protected] Colquitt Regional Medical, Children’s Medical & Moultrie Medical Group, Tift Affinity Group Sarah Sanders Atkinson, Ben Hill, Berrien, Brooks, Clinch, Coffee, Cook, Decatur, Echols, Office: 229-430-5852 Specialist Grady, Irwin, Lanier, Lowndes, Mitchell, Seminole, Thomas Fax: 229-435-6953 Southwest Region Group Accounts: Amelia Medical Plaza, The Pediatric Center, Archbold Email: Medical Center & Medical Group, SGMC, South Georgia Pediatrics and [email protected] Allergy, Valdosta Children’s Healthcare & SGPA, Memorial Pediatrics Brantley, Bryan, Camden, Charlton, Glynn, Lasha Moore Liberty, Long, McIntosh, Pierce, Ware, Wayne Office: 912-339-7166 Manager Fax: 866-753-5773 Group Accounts: Memorial Health Partners, Camden Healthcare Network, St Southeast Region Email: [email protected] Joseph Candler Hospital, St Joseph Employed Physicians Group, Southeast Georgia Health System, ABC Pediatrics Akia Braxton Appling, Bacon, Bulloch, Candler, Chatham, Effingham, Office: 678-206-8425 Specialist Evans, Jeff Davis, Montgomery, Screven, Tattnall, Toombs Fax: 866-753-5773 Southeast Region Email: [email protected] Group Accounts: East Georgia Regional Hospital, Hazelburst Pediatrics, Optim Blanca Statewide Office: 678-556-2246 Rodriguez Fax: 855-286-1806 Ambetter from Peach State Health Plan Supervisor, Email: [email protected] Provider Network Out of Network Physicians & Facilities Office: 866-874-0633 General Inquiries Emergency Room Physicians [email protected] Hospitalists Revised: 03/01/2017 2 Albany Atlanta Macon 2810 Meredyth Drive 1100 Circle 75 Parkway 577 Mulberry Street Suite B Suite 1100 5th Floor, Suite 580 Albany, Georgia 31707 Atlanta, Georgia 30339 Macon, GA 31202 Main: 229-430-5829 Main: 678-556-2300 Main: 478-738-8540 Fax: 229-435-6953 Fax: 877-683-3155 Fax: 855-475-4401 Provider Solutions Department - Territory List Provider Solutions Contact/Fax Numbers Territories Team & Email Addresses Jodi Ingram Office: 229-430-5830 Sr. Manager FQHC Statewide Fax: 855-475-4401 Group Accounts: FQHC Accounts Email: [email protected] Victoria Scott Office: 678-556-2313 Supervisor Statewide Fax: 877-683-3155 FQHC Group Accounts: FQHC Accounts Email: [email protected] Debra Bailey Office: 678-556-2351 Manager Provider Statewide Fax: 877-683-3155 Relations Group Accounts: Occupational, Physical and Speech Therapy Accounts Email: [email protected] Mobile: 770-543-8791 Brawner, CPhT Statewide Pharmacy Provider Liaison Fax: 886-374-1579 Email: [email protected] Office: 678-556-2491 Daniel Scott, CPhT Statewide Pharmacy Provider Liaison Mobile: 678-580-7949 Fax: 866-374-1579 Email: [email protected] Office: 770-370-4445 Lucretia Bell Statewide Project Coordinator Fax: 855-286-1806 Email: [email protected] Office: 770-743-3216 Errol Wade Fax: 855-286-1806 Statewide Project Coordinator Email: [email protected] Monika Place Fax: 855-286-1806 Statewide Project Coordinator Email: [email protected] General Inquiries Out of Network Physicians & Facilities Emergency Room Physicians Hospitalists Office: 866-874-0633 [email protected] Revised: 03/01/2017 3 .