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Individual provider Active NPI Family Medicine Physician · Byron, GA
NPI 1225993454 · NPPES record last updated Dec 19, 2025
Key facts
- NPI
- 1225993454
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- NA (GA)
- Practice address
- 693 Cochran Dr
Byron, GA 31008-6827 - Phone
- (478) 972-1045
- NPI assigned
- Dec 19, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NA | GA | Yes |
Addresses
Primary practice location
693 Cochran Dr
Byron, GA 31008-6827
Mailing address
693 Cochran Dr
Byron, GA 31008-6827
Other providers in Byron, GA
- Alisa Oates
- Shanday Allen
- Myah Anderson
- Beautiful Smiles of Byron LLC
- Avinesh Singh Bhar Jaswindar Singh
- BJ'S Wholesale Club Inc.
- Curt Joseph Blabaum
- Stephanie Black
- Brenda Bradshaw
- Jessica Sutton Braxton
All providers in Byron, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.