NPIMap

Organization Active NPI

Macon Medical Clinic, LLC.

  • Primary Care Clinic/Center
  • Macon, GA
National Provider Identifier
1063823482
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
044065 Issued in GA
Legal business name
MACON MEDICAL CLINIC, LLC.
Practice address
3350 Northside Dr
Macon, GA 31210-2504
Phone
(478) 405-2121
Fax
(478) 405-0114
NPI assigned
May 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Dr. Mohammad Mohabubur Rahman, M.D.NPI 1063515815
Title
Provider/Physician/Owner
Phone
(478) 405-2121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 044065 GA
Medical Specialty Clinic/Center 261QM2500X 044065 GA
Primary Care Clinic/Center 261QP2300X 044065 GA Primary

Addresses

Primary practice location

3350 Northside Dr
Macon, GA 31210-2504

Mailing address

3350 Northside Dr
Macon, GA 31210-2504
Phone (478) 405-2121

National Provider Directory

National Provider Directory

Locations

3350 Northside Dr
Macon, GA 31210
Phone (478) 405-2121

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1063823482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 NORTHSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102504",
            "telephone_number": "478-405-2121",
            "fax_number": "478-405-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 NORTHSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102504",
            "telephone_number": "478-405-2121",
            "fax_number": "478-405-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON MEDICAL CLINIC, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-20",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "MOHABUBUR",
        "authorized_official_title_or_position": "PROVIDER/PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "478-405-2121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "044065",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "044065",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "044065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; 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.