Mutiat Agbasionwe, MD
Individual provider Active NPI Family Medicine Physician · Monroe, GA
NPI 1679142111 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1679142111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 98698 (GA)
- Practice address
- 2161 W Spring St Ste a
Monroe, GA 30655-3196 - Phone
- (770) 267-8464
- NPI assigned
- Jun 19, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Piedmont Medical Care Corporation
Practice addresses (Care Compare)
2161 W Spring St
Suite a
Monroe, GA 30655-3196
Phone (770) 267-8464
Hospital & facility affiliations
- Piedmont Walton Hospital
- Piedmont Eastside Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.62 of 100
- Quality
- 83.25
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240809003100 | GA | Practitioner - Family Practice | 1759782535 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 98698 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piedmont Medical Care Corporation | Family Medicine | Current |
Accepting new patients |
| Piedmont Providers LLC | Past | Accepting new patients |
Locations
105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860
2161 W Spring St
Ste A
Monroe, GA 30655
Phone (770) 267-8464
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 98698 | GA | Yes |
Addresses
Primary practice location
2161 W Spring St Ste a
Monroe, GA 30655-3196
Mailing address
6303 Timber Valley Way SW
Oakwood, GA 30566-0220
Other practice location 1
743 Spring Street, Suite 710
Gainesville, GA 30501
Phone (770) 219-8730
Other names
- Dr. Mutiat Enikanolaiye
Other providers in Monroe, GA
- Jeremy Todd Adams
- Advantage Behavioral Health Systems
- Advantage BHS
- Advantage BHS
- Advantage BHS
- Craig Chike Akoh
- Philomina Akyea - Mensah
- Alcovy Emergency Physicians
- Alcovy Family Medicine, LLC
- Alcovy Spring Counseling Services
All providers in Monroe, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.