NPIMap

Organization Active NPI

Family Medical and Urgent Care Clinic of McDonough, LLC

  • Family Medicine Physician
  • McDonough, GA
National Provider Identifier
1043440530
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
056874 Issued in GA
Legal business name
FAMILY MEDICAL AND URGENT CARE CLINIC OF MCDONOUGH, LLC
Practice address
1631 Hwy 20 W
McDonough, GA 30253-7311
Phone
(770) 288-2822
Fax
(770) 288-2820
NPI assigned
Jul 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Danielle O Eidson
Title
Administrative Operations Manager
Phone
(770) 288-2822

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 056874 GA Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 004088 GA

Addresses

Primary practice location

1631 Hwy 20 W
McDonough, GA 30253-7311

Mailing address

1631 Hwy 20 W
McDonough, GA 30253-7311
Phone (770) 288-2822

Other practice location 1

1075 Bandy Pkwy Ste 120
Locust Grove, GA 30248-7060
Phone (770) 288-2822

Other practice location 2

10263 Highway 19 N Ste 230
Zebulon, GA 30295
Phone (770) 288-2822

Other names 2

  • Family Health Clinic Doing business as
  • Family Medical Clinic of McDonough Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL NA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100423000172 GA Part B Supplier - Clinic/Group Practice 7113054131 Receives reassigned benefits from 37 practitioners
Practice locations: Locust Grove, GA; McDonough, GA; Zebulon, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2287107Family Medical and Urgent Care Clinic LLC1075 Bandy Parkway, Suite 120, Locust Grove, GA 30248ComplianceJul 7, 2027

National Provider Directory

National Provider Directory

Locations

1075 Bandy Pkwy
Locust Grove, GA 30248

1075 Bandy Pkwy
Ste 120
Locust Grove, GA 30248
Phone (770) 288-2822

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAJFBD

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1043440530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 HWY 20 W",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537311",
            "telephone_number": "770-288-2822",
            "fax_number": "770-288-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 HWY 20 W",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537311",
            "telephone_number": "770-288-2822",
            "fax_number": "770-288-2820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1075 Bandy Pkwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "Locust Grove",
            "state": "GA",
            "postal_code": "302487060",
            "country_code": "US",
            "telephone_number": "770-288-2822",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10263 Highway 19 N Ste 230",
            "address_purpose": "LOCATION",
            "city": "Zebulon",
            "state": "GA",
            "postal_code": "30295",
            "country_code": "US",
            "telephone_number": "770-288-2822",
            "fax_number": "770-692-8177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY MEDICAL AND URGENT CARE CLINIC OF MCDONOUGH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-20",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "EIDSON",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "ADMINISTRATIVE OPERATIONS MANAGER",
        "authorized_official_telephone_number": "770-288-2822"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "056874",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004088",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "NA",
            "address_1": "1631 Hwy 20 W",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302537311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medical Clinic of McDonough",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.