Bainbridge Medical Associates, PC
Organization Active NPI Specialist · Bainbridge, GA
NPI 1174705495 · NPPES record last updated Oct 25, 2012
Key facts
- NPI
- 1174705495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- BAINBRIDGE MEDICAL ASSOCIATES, PC
- Practice address
- 1518 Miluli Ave
Bainbridge, GA 39819-4866 - Phone
- (229) 248-8500
- Fax
- (229) 248-8600
- NPI assigned
- Nov 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jon Mallory McRae, M.D.
- Title
- Physician
- Phone
- (229) 248-8580
Practitioners 1
-
Paul J. Bennett, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1021574 | Bainbridge Medical Associates | Certificate of waiver | Jan 25, 2028 |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/5086/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | GA | Yes |
Addresses
Primary practice location
1518 Miluli Ave
Bainbridge, GA 39819-4866
Mailing address
1518 Miluli Ave
Bainbridge, GA 39819-4866
Phone (229) 248-8500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRP6258 | Other | GA | MEDICARE |
Other providers in Bainbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.