Fadoul Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FADOUL MEDICAL LLC

Practice address

350 Hospital Dr
Macon, GA 31217-3838

Phone

(478) 318-8866

NPI assigned

Aug 20, 2025

Last updated

Aug 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Fadoul, MDNPI 1922685544

Title

Owner

Phone

(706) 612-0761

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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.

• Peter Sami Fadoul, MD

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1922685544
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1755648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1205713138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3424",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310243424",
            "telephone_number": "706-612-0761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173838",
            "telephone_number": "478-318-8866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Broadleaf Dr",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312101920",
            "country_code": "US",
            "telephone_number": "478-318-8866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FADOUL MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-20",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A",
        "authorized_official_last_name": "FADOUL",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-612-0761",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chioma Eze-Njoku
• Ngozi Iheuwa Ezeh, MD, RPA-C
• Christian M Ezekwueche, MD
• Sondralyn M Fackler, MD
• William Keith Fackler, MD
• Peter Sami Fadoul, MD
• Catherine Faircloth, NP
• Jennifer Simmons Faircloth, CRNA
• Lacey Foster Faircloth
• Faith Plus Work PT, LLC

• Internal Medicine Physician in Macon, GA
• Providers in Macon, 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 Aug 20, 2025; 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.