NPIMap

Organization Active NPI

Mary M Feldman MD LLC

  • Medical Specialty Clinic/Center
  • Carrollton, GA
National Provider Identifier
1699215541
Registry record updated Feb 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
69043 Issued in GA
Legal business name
MARY M FELDMAN MD LLC
Practice address
100 Professional PL
Ste 110
Carrollton, GA 30117-3874
Phone
(770) 834-0818
Fax
(770) 834-5098
NPI assigned
Feb 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2017

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

Authorized official

Name
Dr. Mary M Feldman, MDNPI 1396767893
Title
Owner
Phone
(504) 231-5544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 69043 GA Primary

Addresses

Primary practice location

100 Professional PL
Ste 110
Carrollton, GA 30117-3874

Mailing address

100 Professional PL
Ste 110
Carrollton, GA 30117-3874
Phone (770) 834-0818

Other names 1

  • CARROLLTON DERMATOLOGY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170417001271 GA Part B Supplier - Clinic/Group Practice 7416233952 Receives reassigned benefits from 1 practitioner
Practice locations: Atlanta, GA; Carrollton, GA

National Provider Directory

National Provider Directory

Locations

410 Dixie St
Carrollton, GA 30117
Phone (678) 796-0681

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1488067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488067200000",
    "number": "1699215541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PL",
            "address_2": "STE 110",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-834-0818",
            "fax_number": "770-834-5098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PL",
            "address_2": "STE 110",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-834-0818",
            "fax_number": "770-834-5098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY M FELDMAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-26",
        "last_updated": "2017-02-26",
        "status": "A",
        "authorized_official_last_name": "FELDMAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-231-5544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "69043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARROLLTON DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.