Mountain Laurel Medical Clinics, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

057558 Issued in GA

Legal business name

MOUNTAIN LAUREL MEDICAL CLINICS, LLC

Practice address

156 N Main St
Clayton, GA 30525-4266

Phone

(706) 782-0293

Fax

(706) 782-0118

NPI assigned

May 3, 2011

Last updated

Jul 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Candio Caruso, MDNPI 1720267891

Title

Owner

Phone

(706) 782-0293

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Candio Caruso, MD

  • Family Medicine Physician
  • Clayton, GA
  • NPI 1720267891
  Authorized official Same address or phone

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1285926766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 N MAIN ST",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254266",
            "telephone_number": "706-782-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 N MAIN ST",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254266",
            "telephone_number": "706-782-0293",
            "fax_number": "706-782-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAUREL MEDICAL CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "CARUSO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CANDIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-782-0293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "057558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456178E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mlmcuc, LLC (Mountain Lakes Medical Group)
• Lisa Mooney
• Harriet Josephine Moseley, LPN
• Sandra Joan Moss, LCSW
• Kyle Bennett Mott, RPH
• Mountain Medical Specilities Inc
• Mountain Physical Therapy Inc
• Mountain View Health & Rehab LLC (Mountain View Health Care)
• Jamie Lynn Nash, MS, OTR/L
• Mary Ellen Nelms, LDO

• Family Medicine Physician in Clayton, GA
• Providers in Clayton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; 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.