Individual provider Active NPI

Antoinette Adjowa Otubea Amevor, MD

  • Pediatric Gastroenterology Physician
  • Macon, GA
National Provider Identifier
1316387202
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
75702 Issued in GA
Practice address
1062 Forsyth St Ste 2E
Macon, GA 31201-8631
Phone
(478) 633-7330
Fax
(478) 633-7360
NPI assigned
Jun 25, 2013
Last updated
Jul 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 75702 GA
Pediatrics Physician 208000000X 6596 GA
Pediatric Gastroenterology Physician 2080P0206X 35.136478 OH
Pediatric Gastroenterology Physician 2080P0206X 75702 GA Primary

Addresses

Primary practice location

1062 Forsyth St Ste 2E
Macon, GA 31201-8631

Mailing address

1062 Forsyth St Ste 2E
Macon, GA 31201-8631
Phone (478) 633-7330

Other names 1

  • Antoinette Walker Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220714002291 GA Practitioner - Pediatric Medicine 6204139892

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Major Hospital Past Accepting new patients
Choa Multispecialty, LLC Pediatrics Past Accepting new patients
Arthur M. Blank Hospital, Inc. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1316387202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1062 FORSYTH ST STE 2E",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312018631",
            "telephone_number": "478-633-7330",
            "fax_number": "478-633-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1062 FORSYTH ST STE 2E",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312018631",
            "telephone_number": "478-633-7330",
            "fax_number": "478-633-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEVOR",
        "first_name": "ANTOINETTE",
        "middle_name": "ADJOWA OTUBEA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "75702",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "6596",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "OH",
            "license": "35.136478",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "GA",
            "license": "75702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTOINETTE",
            "last_name": "WALKER",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.