NPIMap

Individual provider Active NPI

Mary Lu McNeill, MD

  • Family Medicine Physician
  • Dacula, GA
National Provider Identifier
1063551950
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38869 Issued in GA
Practice address
3605 Braselton Hwy
Suite 101
Dacula, GA 30019-4666
Phone
(678) 804-7430
Fax
(678) 804-7418
NPI assigned
Feb 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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 38869 GA Primary

Addresses

Primary practice location

3605 Braselton Hwy
Suite 101
Dacula, GA 30019-4666

Mailing address

3605 Braselton Hwy
Suite 101
Dacula, GA 30019-4666
Phone (678) 804-7430

Other identifiers 1

IdentifierTypeStateIssuer
1063551950OtherGAUPIN C19231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Pain and Rahabilitation PC PastSince Mar 1, 2013 Accepting new patients
Peach Emergency Physicians LLC Past Accepting new patients
Acs Primary Care Physicians - Southeast PC Past Accepting new patients
Apollomd Group Services, LLC Past Accepting new patients
United Emergency Services, Inc. Past Accepting new patients
Pain Consultants of Georgia LLC Past Accepting new patients

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1063551950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 BRASELTON HWY",
            "address_2": "SUITE 101",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194666",
            "telephone_number": "678-804-7430",
            "fax_number": "678-804-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 BRASELTON HWY",
            "address_2": "SUITE 101",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194666",
            "telephone_number": "678-804-7430",
            "fax_number": "678-804-7418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEILL",
        "first_name": "MARY",
        "middle_name": "LU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "38869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN C19231",
            "identifier": "1063551950",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.