Individual provider Active NPI

Melvin G Perry Jr., MD

  • Pediatrics Physician
  • Austell, GA
National Provider Identifier
1639110638
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
46470 Issued in GA
Practice address
3672 Marathon Cir Ste 140
Austell, GA 30106-6821
Phone
(470) 502-0202
Fax
(470) 582-9386
NPI assigned
Jun 9, 2006
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 022738 LA
Pediatrics Physician 208000000X 46470 GA Primary
Pediatric Critical Care Medicine Physician 2080P0203X 49276-020 WI
Pediatric Critical Care Medicine Physician 2080P0203X M9577 TX
Pediatric Critical Care Medicine Physician 2080P0203X O4-30600 KS
Pediatric Critical Care Medicine Physician 2080P0203X 046470 GA
Pediatric Critical Care Medicine Physician 2080P0203X 022738 LA
Pediatric Critical Care Medicine Physician 2080P0203X 2004025527 MO
Pediatric Critical Care Medicine Physician 2080P0203X 40058 TN
Pediatric Critical Care Medicine Physician 2080P0203X 435456 PA
Pediatric Critical Care Medicine Physician 2080P0203X 35.083485 OH
Pediatric Critical Care Medicine Physician 2080P0203X 01057110A IN

Addresses

Primary practice location

3672 Marathon Cir Ste 140
Austell, GA 30106-6821

Mailing address

PO Box 1339
Mableton, GA 30126-1005
Phone (470) 502-0202

Other identifiers 2

IdentifierTypeStateIssuer
1492574MedicaidLA
000910412KMedicaidGA

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200504001077 GA Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 9739147406

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
022738LAMDPharmacist
46470GAMDPediatrics Physician
046470GAMDPediatric Critical Care Medicine Physician
01057110AINMDPediatric Critical Care Medicine Physician
O4-30600KSMDPediatric Critical Care Medicine Physician
2004025527MOMDPediatric Critical Care Medicine Physician
35.083485OHMDPediatric Critical Care Medicine Physician
435456PAMDPediatric Critical Care Medicine Physician
40058TNMDPediatric Critical Care Medicine Physician
49276-020WIMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Total Care Pediatric, PLLC Pediatrics PastSince Oct 20, 2024 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1639110638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1339",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261005",
            "telephone_number": "470-502-0202",
            "fax_number": "470-582-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3672 MARATHON CIR STE 140",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066821",
            "telephone_number": "470-502-0202",
            "fax_number": "470-582-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "MELVIN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "022738",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "46470",
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "WI",
            "license": "49276-020",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "M9577",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "KS",
            "license": "O4-30600",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "GA",
            "license": "046470",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "LA",
            "license": "022738",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MO",
            "license": "2004025527",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TN",
            "license": "40058",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "PA",
            "license": "435456",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "OH",
            "license": "35.083485",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "IN",
            "license": "01057110A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1492574",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000910412K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

Verify at the official NPI Registry.