NPIMap

Organization Active NPI

Eagles Landing OB GYN Associates, PC

  • Obstetrics & Gynecology Physician
  • McDonough, GA
National Provider Identifier
1649225517
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
032893 Issued in GA
Legal business name
EAGLES LANDING OB GYN ASSOCIATES, PC
Practice address
3333 Jodeco Rd Ste D
McDonough, GA 30253-5319
Phone
(404) 455-0110
Fax
(770) 474-7832
NPI assigned
May 22, 2006
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Jackie Livingston
Title
Office Manager
Phone
(770) 474-1919

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X RN070819 NP GA
Advanced Practice Midwife 367A00000X RN119659 GA
Obstetrics & Gynecology Physician 207V00000X 036810 GA
Obstetrics & Gynecology Physician 207V00000X 043639 GA
Obstetrics & Gynecology Physician 207V00000X 046612 GA
Obstetrics & Gynecology Physician 207V00000X 042399 GA
Obstetrics & Gynecology Physician 207V00000X 057739 GA
Obstetrics & Gynecology Physician 207V00000X 056295 GA
Obstetrics & Gynecology Physician 207V00000X 65352 GA
Obstetrics & Gynecology Physician 207V00000X NU
Obstetrics & Gynecology Physician 207V00000X 032893 GA Primary

Addresses

Primary practice location

3333 Jodeco Rd Ste D
McDonough, GA 30253-5319

Mailing address

3333 Jodeco Rd Ste D
McDonough, GA 30253-5319
Phone (770) 474-1919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050707000671 GA Part B Supplier - Clinic/Group Practice 7113963505 Receives reassigned benefits from 12 practitioners
Practice locations: McDonough, GA

National Provider Directory

National Provider Directory

Locations

3333 Jodeco Rd
Ste D
McDonough, GA 30253
Phone (770) 474-1919

350 Country Club Dr
Stockbridge, GA 30281
Phone (770) 474-1919

1513 Union Ave
Ste 1400
Moberly, MO 65270
Phone (660) 263-6677

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1649225517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 JODECO RD STE D",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535319",
            "telephone_number": "770-474-1919",
            "fax_number": "770-474-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 JODECO RD STE D",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535319",
            "telephone_number": "404-455-0110",
            "fax_number": "770-474-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLES LANDING OB GYN ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "LIVINGSTON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-474-1919"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "GA",
            "license": "RN070819 NP",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN119659",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "036810",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "043639",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "046612",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "042399",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "057739",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "056295",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "65352",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "032893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.