Individual provider Active NPI

Roddy Paul Ingraham, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Rocky Face, GA
National Provider Identifier
1760530133
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
13979 Issued in GA
Practice address
2971 Hurricane Rd
Rocky Face, GA 30740-8716
Phone
(706) 673-7889
Fax
(706) 673-3628
NPI assigned
Jan 8, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 13979 GA
Developmental - Behavioral Pediatrics Physician 2080P0006X 13979 GA Primary

Addresses

Primary practice location

2971 Hurricane Rd
Rocky Face, GA 30740-8716

Mailing address

2971 Hurricane Rd
Rocky Face, GA 30740-8716
Phone (706) 673-7889

Other identifiers 1

IdentifierTypeStateIssuer
00006982COtherGAPHYSICIAN IDENTIFICATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081007000532 GA Practitioner - Pediatric Medicine 0446328264 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Emory University School of Medicine, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2971 Hurricane Rd
Rocky Face, GA 30740-8716
Phone (706) 673-7889

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13979GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mill Creek Center P.C. Developmental - Behavioral Pediatrics CurrentSince Oct 13, 2000 Accepting new patients

Locations

2971 Hurricane Rd
Rocky Face, GA 30740
Phone (706) 673-7889

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1760530133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2971 HURRICANE RD",
            "city": "ROCKY FACE",
            "state": "GA",
            "postal_code": "307408716",
            "telephone_number": "706-673-7889",
            "fax_number": "706-673-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2971 HURRICANE RD",
            "city": "ROCKY FACE",
            "state": "GA",
            "postal_code": "307408716",
            "telephone_number": "706-673-7889",
            "fax_number": "706-673-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAHAM",
        "first_name": "RODDY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "13979",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "GA",
            "license": "13979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN IDENTIFICATION",
            "identifier": "00006982C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Face, GA

Sources for this page

Verify at the official NPI Registry.