Active NPI
Melvin G Perry Jr., MD
- Pediatrics Physician
- Austell, GA
National Provider Identifier
1639110638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 46470
- 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, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 12
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1492574 | Medicaid | LA | |
| 000910412K | Medicaid | GA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200504001077 | GA | Practitioner - Pediatric Medicine | 9739147406 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022738 | LA | MD | Pharmacist |
| 46470 | GA | MD | Pediatrics Physician |
| 046470 | GA | MD | Pediatric Critical Care Medicine Physician |
| 01057110A | IN | MD | Pediatric Critical Care Medicine Physician |
| O4-30600 | KS | MD | Pediatric Critical Care Medicine Physician |
| 2004025527 | MO | MD | Pediatric Critical Care Medicine Physician |
| 35.083485 | OH | MD | Pediatric Critical Care Medicine Physician |
| 435456 | PA | MD | Pediatric Critical Care Medicine Physician |
| 40058 | TN | MD | Pediatric Critical Care Medicine Physician |
| 49276-020 | WI | MD | Pediatric Critical Care Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Care Pediatric, PLLC | Pediatrics | Past | 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.
-
- Pediatrics Physician
- Austell, GA
- NPI 1134751068
-
- Pediatrics Physician
- Flushing, NY
- NPI 1619508900
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.