Individual provider Active NPI

Nkechi Mbaezue

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1174523690
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
044014 Issued in GA
Practice address
80 Jessie Hill Jr Dr
Atlanta, GA 30335
Phone
(404) 616-1000
Fax
(404) 616-5933
NPI assigned
Jul 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 044014 GA Primary

Addresses

Primary practice location

80 Jessie Hill Jr Dr
Atlanta, GA 30335

Mailing address

720 Westview Dr SW
Atlanta, GA 30310-1458
Phone (404) 756-1400

Other identifiers 1

IdentifierTypeStateIssuer
00777158DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101129000529 GA Practitioner - Internal Medicine 0749476018 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Morehouse Healthcare, Inc.Group PAC ID 6002701273, 155 clinicians

Practice addresses (Care Compare)

80 Jesse Hill Jr Dr NE
Atlanta, GA 30303-2613
Phone (404) 756-1410

Hospital & facility affiliations

  • Grady Memorial Hospital Hospital, Atlanta, GA, CCN 110079

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
044014GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, P.C. CurrentSince Oct 20, 2015 Accepting new patients
Morehouse Healthcare, Inc. Internal Medicine CurrentSince Sep 1, 1999 Accepting new patients
24 On Physicians, PC CurrentSince Oct 20, 2015 Accepting new patients
Grady Memorial Hospital Corporation Past Accepting new patients

Locations

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

720 Westview Dr SW
Ste 100A
Atlanta, GA 30310

720 Westview Dr SW
Atlanta, GA 30310
Phone (404) 756-1383

75 Piedmont Ave NE
Ste 700
Atlanta, GA 30303
Phone (404) 756-1410

1800 Howell Mill Rd NW
Ste 550
Atlanta, GA 30318
Phone (404) 756-1290

550 Peachtree St NE
Ste 1550
Atlanta, GA 30308
Phone (404) 892-2131

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

1595 Cleveland Ave
East Point, GA 30344
Phone (404) 305-8086

304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1174523690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WESTVIEW DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303101458",
            "telephone_number": "404-756-1400",
            "fax_number": "404-756-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JESSIE HILL JR DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30335",
            "telephone_number": "404-616-1000",
            "fax_number": "404-616-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBAEZUE",
        "first_name": "NKECHI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-27",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "044014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00777158D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.