Edward C. Mack, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

021754 Issued in GA

Practice address

315 Boulevard NE
Suite 444
Atlanta, GA 30312-1200

Phone

(404) 420-0116

Fax

(404) 420-0117

NPI assigned

Sep 21, 2006

Last updated

Sep 7, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edward C Mack M.D.

  • Internal Medicine Physician
  • Decatur, GA
  • NPI 1619305661
  NPD (past) Authorized official

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1245338110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 370569",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "30037",
            "telephone_number": "678-492-5985",
            "fax_number": "404-420-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 BOULEVARD NE",
            "address_2": "SUITE 444",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121200",
            "telephone_number": "404-420-0116",
            "fax_number": "404-420-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "EDWARD",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "021754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000203002D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "5729084",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Elizabeth Macia
• Paul Macias, M.D.
• Alexis Francis Mack
• Alicia L Mack
• Cecelia Marie Mack, LPC
• Galen Denise Mack, PHARM.D.
• Kecia B Mack
• Lisa R Mack, MD
• Michele Mack, MD
• Sean Thomas Mack, MD

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, 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 Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.