Caedel Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

039177 Issued in GA

Legal business name

CAEDEL MEDICAL GROUP

Practice address

1324 Highway 138 SW
Riverdale, GA 30296-1404

Phone

(770) 907-4949

Fax

(770) 907-4022

NPI assigned

Jun 19, 2006

Last updated

Aug 2, 2011By 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

Claire K Willie, MDNPI 1790711141

Title

Physician/Owner

Phone

(770) 907-4949

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIHDBA

Practitioners 18

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.

• Claire K Willie, MD

  • Internal Medicine Physician
  • Riverdale, GA
  • NPI 1790711141
  Medicare reassignment Care Compare group NPD Authorized official
• Grace Nwachukwu Ibeanusi, NP

  • Family Nurse Practitioner
  • McDonough, GA
  • NPI 1366776924
  Medicare reassignment Care Compare group NPD
• James Oliviere Jr., MD

  • Family Medicine Physician
  • Riverdale, GA
  • NPI 1891977146
  Medicare reassignment Care Compare group NPD
• Travoris Demias Cameron, PA-C

  • Medical Physician Assistant
  • Riverdale, GA
  • NPI 1508622143
  Medicare reassignment Care Compare group
• Zabeena Dharani

  • Family Nurse Practitioner
  • Stockbridge, GA
  • NPI 1184322257

  AL

  Medicare reassignment NPD
• Gloria Lucille Harden, FNP-C

  • Family Nurse Practitioner
  • Fort Valley, GA
  • NPI 1295387645
  Medicare reassignment NPD
• Taidesha Chanel Myrick, NP

  • Adult Health Nurse Practitioner
  • Conyers, GA
  • NPI 1710711684
  Medicare reassignment NPD
• Thuy-Ha Bao Trinh, FNP-BC

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1477172641

  Single Specialty

  Medicare reassignment NPD
• Shanika Leyla Myles

  • Physician Assistant
  • Groveland, FL
  • NPI 1902693732

  GA

  Medicare reassignment NPD
• Octavia Perry, FNP-C

  • Nurse Practitioner
  • Nyack, NY
  • NPI 1568931962

  GA

  Medicare reassignment NPD
• Sharon Alston, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Duluth, GA
  • NPI 1811202534
  Medicare reassignment
• Lula Sherri M Mitchell, PA

  • Medical Physician Assistant
  • Riverdale, GA
  • NPI 1710082458
  Medicare reassignment

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312243200000",
    "number": "1710922075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302140009",
            "telephone_number": "770-907-4949",
            "fax_number": "770-907-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302961404",
            "telephone_number": "770-907-4949",
            "fax_number": "770-907-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAEDEL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2011-08-02",
        "status": "A",
        "authorized_official_last_name": "WILLIE",
        "authorized_official_first_name": "CLAIRE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "770-907-4949",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "039177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phyllis Michelle Bryant, RN
• Tawana Bryant
• Maisha Andrell Burnett, CACII
• Amber Thomas Burns, PT, DPT
• C&C Express Urgent Care LLC
• Marlena Celeste Cain, MD
• Calhouns Furniture Consignors
• Came Home Seeing
• Travoris Demias Cameron, PA-C
• Willie Roy Cameron, LPC

• Internal Medicine Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.