Mary Street Logan, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

040466 Issued in GA

Practice address

801 W Gordon St
Thomaston, GA 30286-3426

Phone

(706) 647-8111

Fax

(706) 647-4389

NPI assigned

Aug 26, 2005

Last updated

Mar 3, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267574400000",
    "number": "1225021918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302860008",
            "telephone_number": "706-647-8111",
            "fax_number": "706-647-4389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W GORDON ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302863426",
            "telephone_number": "706-647-8111",
            "fax_number": "706-647-4389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "MARY",
        "middle_name": "STREET",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2010-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "040466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183893252B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00144203",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "925994",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lamme
• Sabrina M. Lancaster, FNP
• Crystal H Lee, LPN
• Sybil Lew, NP
• Allison Birdsong Livingston, APRN
• Main Street Residential Living (Main St)
• Kathy E Mansfield, MD
• Mark E. Cotney, D.C., P.C. (Thomaston Chiropractic Clinic)
• Dawn C McCoy, RD
• Jerica L. McCrary, MPA

• Anesthesiology Physician in Thomaston, GA
• Providers in Thomaston, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.