Maldonado & Moreno, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

046792 Issued in GA

Legal business name

MALDONADO & MORENO, PC

Practice address

375 McDonough Rd
Jackson, GA 30233-1509

Phone

(770) 775-4622

NPI assigned

Feb 8, 2007

Last updated

Apr 10, 2015By 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

Cathy Washington

Title

Billing

Phone

(770) 775-4622

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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.

• Jorge Luis Moreno Jr., M.D.

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1518914597
  Medicare reassignment NPD
• Seema Moreno, O.T.R/L

  • Occupational Therapist
  • Jackson, GA
  • NPI 1649223587
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428624000000",
    "number": "1699815340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MCDONOUGH RD",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MCDONOUGH RD",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331509",
            "telephone_number": "770-775-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALDONADO & MORENO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-04-10",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "770-775-4622"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "046792",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "022255",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT002221",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "555980929C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000211549A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000885024A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "GRP4245",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Ronald Lester, LCSW
• Auriel Renae Lewis, NP
• Henrietta Lindsay, LCSW
• Michele A Lucien, PTA
• Shashi Madan, MD
• Sheila Mallory, FNP-C
• Shanita Ann McCall
• Jennifer McElhannon, OCCUPATIONAL THERAPI
• McIntosh Trail Community Service Board
• McIntosh Trail Community Service Board

• Family Medicine Physician in Jackson, GA
• Providers in Jackson, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; 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.