Moultrie Medical PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MOULTRIE MEDICAL PC

Practice address

2970 Clairmont Rd NE Ste 210
Brookhaven, GA 30329-4414

Phone

(256) 302-3505

NPI assigned

Jul 27, 2023

Organization subpart

No

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

Authorized official

Name

John Moultrie, MDNPI 1417393893

Title

Owner

Phone

(256) 302-3505

Specialties & licenses 1

Addresses

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

Locations

Practitioners 1

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

• John Moultrie

  • Family Medicine Physician
  • Sandy Springs, GA
  • NPI 1417393893
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1215618640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2847 CEDAR CANYON CT NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303454021",
            "telephone_number": "256-302-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 CLAIRMONT RD NE STE 210",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303294414",
            "telephone_number": "256-302-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "MOULTRIE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-302-3505",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andres Montoya, RBT
• Shayna Moore, RBT
• Amy Moreno
• Aaliyah Morgan, RBT
• Mother S Love PWH PLLC
• Movement Matters LLC
• Carolyn Suzanne Mueller, MS, RDN, LD, CDE
• Allyssah Mullis, RBT
• Anna Jayde Mullis, M.ED, LAPC
• Zachry Munson, MS, BCBA

• Primary Care Clinic/Center in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.