NPIMap

Organization Active NPI

Edward C Mack M.D.

  • Internal Medicine Physician
  • Decatur, GA
National Provider Identifier
1619305661
Registry record updated Oct 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
021754 Issued in GA
Legal business name
EDWARD C MACK M.D.
Practice address
2855 Candler Rd
Suite 06
Decatur, GA 30034-1415
Phone
(404) 241-0103
Fax
(404) 241-0069
NPI assigned
Oct 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2013

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

Authorized official

Name
Dr. Edward C Mack, M.D.NPI 1245338110
Title
President
Phone
(404) 241-0103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 021754 GA Primary

Addresses

Primary practice location

2855 Candler Rd
Suite 06
Decatur, GA 30034-1415

Mailing address

2855 Candler Rd
Suite 06
Decatur, GA 30034-1415
Phone (404) 241-0103

Other identifiers 1

IdentifierTypeStateIssuer
000203002DMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383004800000",
    "number": "1619305661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 CANDLER RD",
            "address_2": "SUITE 06",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341415",
            "telephone_number": "404-241-0103",
            "fax_number": "404-241-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 CANDLER RD",
            "address_2": "SUITE 06",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341415",
            "telephone_number": "404-241-0103",
            "fax_number": "404-241-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD C MACK M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2013-10-29",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-241-0103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "021754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000203002D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.