NPIMap

Individual provider Active NPI

Mike W. Ou, M.D.

  • Family Medicine Physician
  • Bowdon, GA
National Provider Identifier
1063442937
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
053301 Issued in GA
Practice address
1125 E Highway 166
Bowdon, GA 30108-2401
Phone
(770) 258-5424
Fax
(770) 838-8980
NPI assigned
Jul 4, 2006
Last updated
Jun 18, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 053301 GA Primary

Addresses

Primary practice location

1125 E Highway 166
Bowdon, GA 30108-2401

Mailing address

119 Ambulance Dr
Suite 202
Carrollton, GA 30117-3857
Phone (770) 836-9250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040517001561 GA Practitioner - Family PracticePractitioner - General Practice 7113917477 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
University of Miami, LM Miller School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TMC West Carroll Family Healthcare Center IncGroup PAC ID 5991616039, 3 clinicians
Tanner Medical Group IncGroup PAC ID 2769536143, 120 clinicians

Practice addresses (Care Compare)

1125 E Hwy 166
Bowden, GA 30108-2401
Phone (770) 258-5424

225 Maple View Dr
Suite 102
Carrollton, GA 30117-8471
Phone (770) 812-5678

690 Dallas Hwy
Villa Rica, GA 30180-1263

690 Dallas Hwy 207a
Villa Rica, GA 30180-1263
Phone (770) 456-3646

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Family Medicine CurrentSince Mar 23, 2020 Accepting new patients
TMC West Carroll Family Healthcare Center Inc Family Medicine CurrentSince Mar 28, 2005 Accepting new patients

Locations

1125 E Highway 166
Bowdon, GA 30108
Phone (770) 258-5424

119 Ambulance Dr
Ste 202
Carrollton, GA 30117
Phone (770) 838-8710

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

2906 Franklin Pkwy
Franklin, GA 30217
Phone (706) 675-6949

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1063442937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173857",
            "telephone_number": "770-836-9250",
            "fax_number": "770-836-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E HIGHWAY 166",
            "city": "BOWDON",
            "state": "GA",
            "postal_code": "301082401",
            "telephone_number": "770-258-5424",
            "fax_number": "770-838-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OU",
        "first_name": "MIKE",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowdon, GA

Sources for this page

Verify at the official NPI Registry.