Theodora Mbanefo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

056596 Issued in GA

Practice address

3650 Steve Reynolds Blvd
Department of Internal Medicine
Duluth, GA 30096-4506

Phone

(770) 931-6065

NPI assigned

Dec 1, 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

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

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376611764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051773",
            "telephone_number": "404-364-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 STEVE REYNOLDS BLVD",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964506",
            "telephone_number": "770-931-6065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBANEFO",
        "first_name": "THEODORA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "056596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Amy Mauk, M.ED., CCC-SLP
• Maxa Internal Medicine Associates PC
• Richard Reid Maxa, M.D.
• Shawnay Nicole Mazell, M.D.
• Thomas J Mazzuckelli, PHD, DMD
• MBS Connection LLC
• Ijuana McCain, LAPC
• Nicole McCarthan, ATC
• Khelsea M. McCier, CPNP (N.P.)
• Aeriel McClain

• Internal Medicine Physician in Duluth, GA
• Providers in Duluth, 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 Jul 8, 2007; 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.