Dorothy M Mack, MPH, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003043 Issued in GA

Practice address

655 7TH St
Robins Afb, GA 31098-2227

Phone

(478) 327-7805

Fax

(478) 327-7816

NPI assigned

Aug 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1346250099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 7TH ST",
            "city": "ROBINS AFB",
            "state": "GA",
            "postal_code": "310982227",
            "telephone_number": "478-327-7805",
            "fax_number": "478-327-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 7TH ST",
            "city": "ROBINS AFB",
            "state": "GA",
            "postal_code": "310982227",
            "telephone_number": "478-327-7805",
            "fax_number": "478-327-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "DOROTHY",
        "middle_name": "M",
        "credential": "MPH, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505983680C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurianna N Lively, LCSW
• Delvida L. Long, PH.D.
• William Matthew Lucas, M.D.
• Tina Marie Luichinger, OD
• David Alan Lunsford Jr., DPT
• Kimberly Marketto, LCSW
• Carolye Valerie Mason, D.M.D
• Colin Daniel McCloskey, DO
• Page Wilding McNall, DDS
• Joanna S McPherson, DDS

• Physician Assistant in Robins Afb, GA
• Providers in Robins Afb, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.