NPIMap

Organization Active NPI

Macon Occupational Medicine

  • Occupational Medicine Physician
  • Fort Valley, GA
National Provider Identifier
1669973186
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
Legal business name
MACON OCCUPATIONAL MEDICINE
Practice address
1005 State University Dr
Fort Valley, GA 31030-4313
Phone
(478) 972-8900
NPI assigned
Feb 21, 2018
Organization subpart
Yes
Parent organization
MACON OCCUPATIONAL MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Authorized official

Name
Leonard Bevill
Title
President/Ceo
Phone
(478) 751-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083X0100X Primary

Addresses

Primary practice location

1005 State University Dr
Fort Valley, GA 31030-4313

Mailing address

124 3Rd St
Macon, GA 31201-3404
Phone (478) 751-2925

Other names 1

  • Fort Valley State University Student Health Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mom-Ykk Clinic5 organizations share this tax ID, including this one
Part of
Mom-Ykk Clinic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1005 State University Dr
Fort Valley, GA 31030
Phone (478) 825-6195

124 3rd St
Macon, GA 31201
Phone (478) 751-2900

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1669973186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 3RD ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013404",
            "telephone_number": "478-751-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 STATE UNIVERSITY DR",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310304313",
            "telephone_number": "478-972-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON OCCUPATIONAL MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACON OCCUPATIONAL MEDICINE",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "BEVILL",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "478-751-2900"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Valley State University Student Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Valley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.