Jon Mallory McRae Sr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7603 Issued in GA

Practice address

914 E Shotwell St
Bainbridge, GA 39819-4148

Phone

(229) 246-7637

NPI assigned

Jun 7, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1629018718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 E SHOTWELL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194148",
            "telephone_number": "229-246-7637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 E SHOTWELL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194148",
            "telephone_number": "229-246-7637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCRAE",
        "first_name": "JON",
        "middle_name": "MALLORY",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "7603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Landin John Marzolf, D.C.
• Jimmy Foster Maxwell, D.M.D., P.C.
• Pauline Maxwell, LPC
• Bethany Breckenridge McElyea, LPC
• Amanda McNease, SLP
• Jon Mallory McRae Jr., M.D.
• Crystal Joy Micken, LPC, CRC
• Milestones Pediatric Therapy, LLC
• Emilee Poppell Miller
• Gordon Chason Miller, M.D.

• General Practice Dentistry in Bainbridge, GA
• Providers in Bainbridge, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.