NPIMap

Organization Active NPI

Guardion Medical

  • Electroneurodiagnostic Specialist/Technologist
  • Macon, GA
National Provider Identifier
1699394825
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X
Legal business name
GUARDION MEDICAL
Practice address
624 Plum St Ste a
Macon, GA 31201-2811
Phone
(478) 273-3831
Fax
(855) 940-0206
NPI assigned
Apr 8, 2020
Last updated
Jan 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Daniel Lee Willett, CNIMNPI 1457717332
Title
Member
Phone
(478) 273-3831

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
Electroneurodiagnostic Specialist/Technologist 246ZE0600X NU Primary

Addresses

Primary practice location

624 Plum St Ste a
Macon, GA 31201-2811

Mailing address

624 Plum St Ste a
Macon, GA 31201-2811
Phone (478) 273-3831

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250227000655 GA Part B Supplier - Clinic/Group Practice 5092235549 Receives reassigned benefits from 3 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

420 Charter Blvd
Ste 402A
Macon, GA 31210
Phone (404) 617-7143

Practitioners & affiliated clinicians

Practitioners 7

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": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1699394825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 PLUM ST STE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012811",
            "telephone_number": "478-273-3831",
            "fax_number": "855-940-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 PLUM ST STE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012811",
            "telephone_number": "478-273-3831",
            "fax_number": "855-940-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDION MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2025-01-03",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "WILLETT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "478-273-3831",
        "authorized_official_credential": "CNIM"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.