NPIMap

Organization Active NPI

Ga Diagnostic Providers LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Macon, GA
National Provider Identifier
1538768296
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
Legal business name
GA DIAGNOSTIC PROVIDERS LLC
Practice address
5400 Riverside Dr Ste 202
Macon, GA 31210-0818
Phone
(478) 787-0059
Fax
(855) 428-4597
NPI assigned
Oct 22, 2020
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Authorized official

Name
Mr. Mark Shane Mobley, RRT
Title
President
Phone
(478) 972-8865

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Sleep Disorder Diagnostic Clinic/Center 261QS1200X NU Primary
Physiological Laboratory 293D00000X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

5400 Riverside Dr Ste 202
Macon, GA 31210-0818

Mailing address

5400 Riverside Dr Ste 202
Macon, GA 31210-0818
Phone (478) 972-8865

Other practice location 1

100 Tommy Stalnaker Dr Ste A
Warner Robins, GA 31088-1403
Phone (478) 787-0059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250701004043 GA Part B Supplier - Clinic/Group Practice 6406369594 Receives reassigned benefits from 5 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

5400 Riverside Dr
Ste 101
Macon, GA 31210

5400 Riverside Dr
Ste 202
Macon, GA 31210
Phone (478) 787-0059

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1538768296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 RIVERSIDE DR STE 202",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100818",
            "telephone_number": "478-972-8865",
            "fax_number": "855-428-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 RIVERSIDE DR STE 202",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100818",
            "telephone_number": "478-787-0059",
            "fax_number": "855-428-4597"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Tommy Stalnaker Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Warner Robins",
            "state": "GA",
            "postal_code": "310881403",
            "country_code": "US",
            "telephone_number": "478-787-0059",
            "fax_number": "855-428-4597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GA DIAGNOSTIC PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "MOBLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-972-8865",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.