Ocmulgee Medical Services, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

OCMULGEE MEDICAL SERVICES, LLC

Practice address

911 Plaza Ave
Eastman, GA 31023-6785

Phone

(478) 374-4410

Fax

(478) 374-1712

NPI assigned

Jul 24, 2008

Organization subpart

No

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

Authorized official

Name

Robert Peacock

Title

Business Manager

Phone

(478) 374-4410

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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

• Brandi Michelle Wynne, MD

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1316152770

  GA, Internal Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1720243124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236785",
            "telephone_number": "478-374-4410",
            "fax_number": "478-374-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236785",
            "telephone_number": "478-374-4410",
            "fax_number": "478-374-1712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCMULGEE MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-24",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "PEACOCK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "478-374-4410"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana W Mullis, DMD
• Debbie Jones Mullis, LCSW
• James Michael Mullis
• Ocmulgee Family Medicine LLC.
• Ocmulgee Internal Medicine and Nephrology, LLC
• Ocmulgee Urology, LLC
• Brande Barlow Ogden, COTA/L
• Clayton Shane Oliver, DMD
• Tammie Dianne Oliver, FNP
• Amanda Llyn Parkerson, FNP-C

• All providers in Eastman, GA
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.