NPIMap

Organization Active NPI

Central Georgia Gastroenterology, LLC

  • Specialist
  • Macon, GA
National Provider Identifier
1285925941
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
037564 Issued in GA
Legal business name
CENTRAL GEORGIA GASTROENTEROLOGY, LLC
Practice address
791 Poplar St
Macon, GA 31201-2045
Phone
(478) 474-1769
NPI assigned
Apr 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

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

Authorized official

Name
Ms. Leslie Dixon
Title
Billing Office Manager
Phone
(478) 474-1769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 037564 GA Primary

Addresses

Primary practice location

791 Poplar St
Macon, GA 31201-2045

Mailing address

791 Poplar St
Macon, GA 31201-2045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110629000173 GA Part B Supplier - Clinic/Group Practice 9739367459 Receives reassigned benefits from 6 practitioners
Practice locations: Macon, GA; Milledgeville, GA

National Provider Directory

National Provider Directory

Locations

1011 Fernwood Dr
Milledgeville, GA 31061
Phone (478) 457-3900

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1285925941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 POPLAR ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 POPLAR ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012045",
            "telephone_number": "478-474-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL GEORGIA GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "BILLING OFFICE MANAGER",
        "authorized_official_telephone_number": "478-474-1769",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "037564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.