MCMD LLC
Organization Active NPI Primary Care Clinic/Center · Athens, AL
NPI 1477068468 · NPPES record last updated Mar 16, 2022
Key facts
- NPI
- 1477068468
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 32665 (AL)
- Legal business name
- MCMD LLC
- Practice address
- 22292 US Highway 72
Athens, AL 35613-2604 - Phone
- (256) 614-2444
- NPI assigned
- Dec 12, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew Bragg Caldwell, MD
- Title
- Physician
- Phone
- (256) 614-2444
Practitioners 3
-
Holly Suzanne Adams, NP-C
-
Jaime Hamilton Willey, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180618001117 | AL | Part B Supplier - Clinic/Group Practice | 7618222597 |
Receives reassigned benefits from 3 practitioners Practice locations: Athens, AL |
National Provider Directory
Locations
101 Fitness Way
Ste 1200
Athens, AL 35611
Phone (256) 232-0636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 32665 | AL | Yes |
Addresses
Primary practice location
22292 US Highway 72
Athens, AL 35613-2604
Mailing address
22292 US Highway 72
Athens, AL 35613-2604
Phone (256) 614-2444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32665 | Other | AL | STATE LICENSE |
Other providers in Athens, AL
- Nancy D McDonald
- Winston Locker McDonald
- Scott McGee
- Carson Wade McGregory
- Haley McInnis
- Courtney McNatt
- Morgan C McNeese
- Riley Llewellyn McRae
- Tammy McWhirter
- Cynthia McWilliams
All providers in Athens, AL · Primary Care Clinic/Center in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.