NPIMap

Organization Active NPI

Lillette a Intaphan MD LLC

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1649414657
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
033601 Issued in GA
Legal business name
LILLETTE A INTAPHAN MD LLC
Practice address
432 Poplar St
Suite B
Macon, GA 31201-3336
Phone
(478) 475-1299
Fax
(478) 405-7928
NPI assigned
Apr 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

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

Authorized official

Name
Lillette A Intaphan
Title
MDC
Phone
(478) 475-1299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 033601 GA Primary

Addresses

Primary practice location

432 Poplar St
Suite B
Macon, GA 31201-3336

Mailing address

PO Box 26040
Macon, GA 31221-6040
Phone (478) 475-1299

Other identifiers 1

IdentifierTypeStateIssuer
DP2683OtherGARR MDC

National Provider Directory

National Provider Directory

Locations

432 Poplar St
#B
Macon, GA 31201

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255910400000",
    "number": "1649414657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26040",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312216040",
            "telephone_number": "478-475-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 POPLAR ST",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013336",
            "telephone_number": "478-475-1299",
            "fax_number": "478-405-7928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLETTE A INTAPHAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-22",
        "last_updated": "2009-10-19",
        "status": "A",
        "authorized_official_last_name": "INTAPHAN",
        "authorized_official_first_name": "LILLETTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MDC",
        "authorized_official_telephone_number": "478-475-1299"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "033601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MDC",
            "identifier": "DP2683",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; 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.