Ketamine Centers of Central Georgia LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

KETAMINE CENTERS OF CENTRAL GEORGIA LLC

Practice address

3312 Northside Dr Ste D235
Macon, GA 31210-0426

Phone

(478) 201-9220

Fax

(478) 203-9322

NPI assigned

Oct 21, 2024

Last updated

Oct 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Judah Greenberg, MD

Title

Doctor Owner

Phone

(478) 201-9220

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Center of Central Georgia Other name

Locations

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

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1053132308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6275 RIVOLI DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101456",
            "telephone_number": "478-363-0016",
            "fax_number": "478-203-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 NORTHSIDE DR STE D235",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100426",
            "telephone_number": "478-201-9220",
            "fax_number": "478-203-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE CENTERS OF CENTRAL GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-20",
        "status": "A",
        "authorized_official_last_name": "GREENBERG",
        "authorized_official_first_name": "JUDAH",
        "authorized_official_title_or_position": "DOCTOR OWNER",
        "authorized_official_telephone_number": "478-201-9220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Center of Central Georgia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Internal Medicine Physician in Macon, GA
• Providers in Macon, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.