Medical Care of Lagrange, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

048066 Issued in GA

Legal business name

MEDICAL CARE OF LAGRANGE, LLC

Practice address

300 Medical Dr
Suite 701
Lagrange, GA 30240-4130

Phone

(706) 882-8971

Fax

(706) 882-8991

NPI assigned

Jan 14, 2008

Organization subpart

No

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

Authorized official

Name

Debbie Morris

Title

Business Office MGR

Phone

(706) 882-8971

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Anil R Modi, MD

  • Internal Medicine Physician
  • Lagrange, GA
  • NPI 1508868704
  Medicare reassignment

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1104002799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MEDICAL DRIVE",
            "address_2": "SUITE 701",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "30240",
            "telephone_number": "706-882-8971",
            "fax_number": "706-882-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEDICAL DR",
            "address_2": "SUITE 701",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404130",
            "telephone_number": "706-882-8971",
            "fax_number": "706-882-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CARE OF LAGRANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MGR",
        "authorized_official_telephone_number": "706-882-8971"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "048066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00843873G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James P McGowan, M.D.
• Michelle Denise McMickin
• Darrell L McMullen Sr., CASE MANAGER
• Keisha McNeill, MS, LPC
• Med Ventures MRI, LLC
• Medventures Physical Therapy, LLC
• Erin Meeks, MD
• Ryan Meeks, PHARMD
• Mental Health Services of Georgia
• Jessica Teara Meriwether, LPC

• Internal Medicine Physician in Lagrange, GA
• Providers in Lagrange, 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 Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.