Moultrie Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

MOULTRIE PEDIATRICS, LLC

Practice address

1 Sweet Bay CT
Suite a
Moultrie, GA 31768-6756

Phone

(229) 985-1293

Fax

(229) 891-2123

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Marion A Wills, M.D.

Title

Owner

Phone

(229) 985-1293

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Children's Medical Group of SW GA Doing business as

Locations

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1679766299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760129",
            "telephone_number": "229-985-1293",
            "fax_number": "229-891-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SWEET BAY CT",
            "address_2": "SUITE A",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686756",
            "telephone_number": "229-985-1293",
            "fax_number": "229-891-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "WILLS",
        "authorized_official_first_name": "MARION",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-985-1293",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACHSTATE",
            "identifier": "3083",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "396284",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300035718A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Medical Group of SW GA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Moultrie Healthway, LLC
• Moultrie I Enterprises, LLC
• Moultrie Internal Medicine Associates PC
• Moultrie Orthodontics, P.C.
• Moultrie Orthopedic Clinic, P.C.
• Moultrie Urological Clinic, Inc
• Moultrie Urology ASC
• Mrs Homecare, Inc.
• Mukul Khurana
• Laura Mullis, LCSW

• Pediatrics Physician in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.