Pediatric Care of Macon, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

020359 Issued in GA

Legal business name

PEDIATRIC CARE OF MACON, LLC

Practice address

3951 Ridge Ave
Suite a
Macon, GA 31210-5050

Phone

(478) 475-1006

Fax

(478) 475-0787

NPI assigned

Nov 6, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Leigh Howard McDaniel

Title

Practice Manager

Phone

(478) 475-1006

Specialties & licenses 1

Addresses

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

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225929600000",
    "number": "1760636575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3951 RIDGE AVE",
            "address_2": "SUITE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312105050",
            "telephone_number": "478-475-1006",
            "fax_number": "478-475-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3951 RIDGE AVE",
            "address_2": "SUITE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312105050",
            "telephone_number": "478-475-1006",
            "fax_number": "478-475-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARE OF MACON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-06",
        "last_updated": "2008-11-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "LEIGH",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "478-475-1006",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "020359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.