NPIMap

Organization Active NPI

S R Adcock MD PC

  • Orthopaedic Surgery Physician
  • Moultrie, GA
National Provider Identifier
1689667545
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
21934 Issued in GA
Legal business name
S R ADCOCK MD PC
Practice address
1414 S Main St
Moultrie, GA 31768-5812
Phone
(229) 985-8713
Fax
(229) 985-5013
NPI assigned
Aug 25, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Audrey F Dukes
Title
Cfo
Phone
(229) 985-8713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 21934 GA Primary

Addresses

Primary practice location

1414 S Main St
Moultrie, GA 31768-5812

Mailing address

1414 S Main St
Moultrie, GA 31768-5812
Phone (229) 985-8713

Other identifiers 1

IdentifierTypeStateIssuer
00264063BMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689667545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685812",
            "telephone_number": "229-985-8713",
            "fax_number": "229-985-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685812",
            "telephone_number": "229-985-8713",
            "fax_number": "229-985-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S R ADCOCK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUKES",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-985-8713",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "21934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00264063B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.