John F Mynatt Jr., MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

041469 Issued in GA

Practice address

5040 Bill Gardner Pkwy
Suite 100
Locust Grove, GA 30248-3645

Phone

(678) 583-5437

Fax

(678) 583-5484

NPI assigned

Mar 20, 2006

Last updated

Jun 23, 2008By 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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jfmmd@lgp.pcc-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Locust Grove Pediatrics

  • Pediatrics Physician
  • Locust Grove, GA
  • NPI 1174693519
  NPD (past) Authorized official

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214179200000",
    "number": "1629037528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 BILL GARDNER PKWY",
            "address_2": "SUITE 100",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483645",
            "telephone_number": "678-583-5437",
            "fax_number": "678-583-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 BILL GARDNER PKWY",
            "address_2": "SUITE 100",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483645",
            "telephone_number": "678-583-5437",
            "fax_number": "678-583-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYNATT",
        "first_name": "JOHN",
        "middle_name": "F",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2008-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "041469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000964785J",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000964785B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52701109002",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tequella Muhammad
• Multi-Services and Community Supports, LLC
• Andrea Joy Murdock, L.M.T.
• Charlotte Murray
• Dawnyse Myers, ATC/L
• Nacolby's House, Incorporated
• National Healthcare Unlimited
• Neshama Health Alliance LLC
• Tykara Syncere Newman
• Walter Newton

• Pediatrics Physician in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.