Active NPI
Edmond J McDonnell Jr., M.D.
- Ophthalmology Physician
- Fort Stewart, GA
National Provider Identifier
1124393061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- D0029009
- Practice address
- 1061 Harmon Avenue
Fort Stewart, GA 31314-5674 - Phone
- (912) 435-6633
- NPI assigned
- Mar 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | D0029009 | MD | Primary |
Addresses
Primary practice location
1061 Harmon Avenue
Fort Stewart, GA 31314-5674
Mailing address
1061 Harmon Avenue
Fort Stewart, GA 31314-5674
Phone (912) 435-6633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0029009 | MD | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414108800000",
"number": "1124393061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVENUE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145674",
"telephone_number": "912-435-6633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1061 HARMON AVENUE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145674",
"telephone_number": "912-435-6633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONNELL",
"first_name": "EDMOND",
"middle_name": "J",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-10",
"last_updated": "2014-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MD",
"license": "D0029009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.