Moultrie Urology ASC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

035-219 Issued in GA

Legal business name

MOULTRIE UROLOGY ASC

Practice address

2 Hospital Park
Moultrie, GA 31768-6700

Phone

(229) 985-3066

Fax

(229) 890-2092

NPI assigned

Jun 7, 2007

Last updated

Jan 8, 2010By 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

Mrs. Maha Kassis Baddour, RMM

Title

Office Manager

Phone

(229) 985-3066

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262908800000",
    "number": "1700089695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686700",
            "telephone_number": "229-985-3066",
            "fax_number": "229-890-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686700",
            "telephone_number": "229-985-3066",
            "fax_number": "229-890-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE UROLOGY ASC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2010-01-08",
        "status": "A",
        "authorized_official_last_name": "BADDOUR",
        "authorized_official_first_name": "MAHA",
        "authorized_official_middle_name": "KASSIS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "229-985-3066",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RMM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "035-219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00919619A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moultrie Internal Medicine Associates PC
• Moultrie Orthodontics, P.C.
• Moultrie Orthopedic Clinic, P.C.
• Moultrie Pediatrics, LLC (Children's Medical Group of SW GA)
• Moultrie Urological Clinic, Inc
• Mrs Homecare, Inc. (Mrs of Moultrie)
• Mukul Khurana
• Laura Mullis, LCSW
• Erick Myrtil, MD
• National Vision, Inc.

• Ambulatory Surgical Clinic/Center in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2010; 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.