NPIMap

Organization Active NPI

Medical Group of Central Georgia, LLC

  • Internal Medicine Physician
  • Warner Robins, GA
National Provider Identifier
1083860779
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDICAL GROUP OF CENTRAL GEORGIA, LLC
Practice address
2054 Watson Blvd
Warner Robins, GA 31093-3634
Phone
(478) 918-0770
Fax
(478) 918-0771
NPI assigned
Aug 13, 2008
Last updated
Aug 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Authorized official

Name
Dr. Mohammad N Al-Shroof, M.D.NPI 1578519286
Title
Owner
Phone
(478) 918-0770

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2054 Watson Blvd
Warner Robins, GA 31093-3634

Mailing address

PO Box 5048
Macon, GA 31208-5048
Phone (478) 918-0770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081007000685 GA Part B Supplier - Clinic/Group Practice 1658449491 Receives reassigned benefits from 17 practitioners
Practice locations: Butler, GA; Warner Robins, GA

National Provider Directory

National Provider Directory

Locations

2054 Watson Blvd
Warner Robins, GA 31093
Phone (478) 918-0770

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1083860779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5048",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312085048",
            "telephone_number": "478-918-0770",
            "fax_number": "478-918-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2054 WATSON BLVD",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933634",
            "telephone_number": "478-918-0770",
            "fax_number": "478-918-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GROUP OF CENTRAL GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "AL-SHROOF",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-918-0770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.