NPIMap

Organization Active NPI

DMC Physician Group LLC

  • Rural Health Clinic/Center
  • Fitzgerald, GA
National Provider Identifier
1235807769
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DMC PHYSICIAN GROUP LLC
Practice address
200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone
(229) 424-7100
NPI assigned
Aug 31, 2021
Last updated
Aug 31, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Paige Wynn
Title
Ceo
Phone
(229) 424-7100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

200 Perry House Rd
Fitzgerald, GA 31750-8857

Mailing address

200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone (229) 424-7100

National Provider Directory

National Provider Directory
Tax ID family
DMC Physician Group LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 Perry House Rd
Fitzgerald, GA 31750
Phone (229) 424-1461

NPI Registry JSON

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1235807769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PERRY HOUSE RD",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508857",
            "telephone_number": "229-424-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PERRY HOUSE RD",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508857",
            "telephone_number": "229-424-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMC PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-424-7100"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitzgerald, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.