CC Metabolics of Georgia LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CC METABOLICS OF GEORGIA LLC

Practice address

931 E Winthrope Ave
Millen, GA 30442-1839

Phone

(478) 239-0230

Fax

(478) 210-1107

NPI assigned

Nov 28, 2022

Last updated

Nov 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gary WaggonerNPI 1669151593

Title

Credentialing Manager

Phone

(214) 202-1023

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Gary Waggoner

  • Durable Medical Equipment & Medical Supplies
  • Corsicana, TX
  • NPI 1669151593
  Authorized official Same address or phone

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1679283030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PINE VALLEY RD SW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654338",
            "telephone_number": "904-860-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 E WINTHROPE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421839",
            "telephone_number": "478-239-0230",
            "fax_number": "478-210-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CC METABOLICS OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "214-202-1023"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Buckles
• Burke Hospital Company (Burke Health Primary Care)
• Burke Hospital Company (Burke Orthopedics)
• Burke Hospital Company (Southeastern Spine and Pain)
• Angela Carr
• Prakul Chandra, MD
• Community Service Board of Middle Georgia
• Community Service Board of Middle Georgia
• Costrini & Meadows, PC
• Tiffany Davis, PHARMD.

• Internal Medicine Physician in Millen, GA
• Providers in Millen, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.