Metro Infectious Disease Consultants LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

METRO INFECTIOUS DISEASE CONSULTANTS LLC

Doing business as

Midc

Practice address

7823 Spivey Station Blvd Ste 360
Jonesboro, GA 30236-2886

Phone

(770) 741-1750

NPI assigned

Nov 12, 2024

Last updated

Nov 12, 2024By 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

Russell M Petrak, MDNPI 1376539692

Title

Managing Partner

Phone

(888) 220-6432

Specialties & licenses 1

Addresses

Other names 1

• MIDC Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Metro Infectious Disease Consultants, LLC

  dba Midc, LLC

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1235125717

  3072425784

  Same PAC ID
• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Huntsville, AL
  • NPI 1659702223

  3072425784

  Same PAC ID
• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Plymouth, MI
  • NPI 1841530250

  3072425784

  Same PAC ID

Locations (25 of 110)

Practitioners 504

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.

• Russell M Petrak, MD

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1376539692
  Authorized official Same address or phone
• Christy Jo Morgan Adams

  • Physician Assistant
  • Riverdale, GA
  • NPI 1518477785
  NPD
• Kristina Marie Angelo, D.O.

  • Infectious Disease Physician
  • Atlanta, GA
  • NPI 1144553249
  NPD
• Milton Derrick Boden, M.D.

  • Infectious Disease Physician
  • Decatur, GA
  • NPI 1720037310
  NPD
• Gustavo Adolfo Contreras Anez, MD

  • Infectious Disease Physician
  • Jonesboro, GA
  • NPI 1760903330
  NPD
• Juliana De Fatima Da Silva, MD

  • Infectious Disease Physician
  • Atlanta, GA
  • NPI 1598051310
  NPD
• Melina Paola Diaz-Cardenas, M.D.

  • Infectious Disease Physician
  • Peachtree City, GA
  • NPI 1548422843
  NPD
• Alexandra Wolcott Dretler, MD

  • Infectious Disease Physician
  • Decatur, GA
  • NPI 1811251762
  NPD
• Robin Henry Dretler, M.D.

  • Infectious Disease Physician
  • Decatur, GA
  • NPI 1871545459
  NPD
• Griffen Taylor Allan George, M.D.

  • Infectious Disease Physician
  • Stockbridge, GA
  • NPI 1972910339
  NPD
• Marla C Green, FNP-C

  • Family Nurse Practitioner
  • Jonesboro, GA
  • NPI 1639580780
  NPD
• Cynthia McClendon

  • Family Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1831629609
  NPD

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1770307191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR STE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "630-220-6432",
            "fax_number": "630-654-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7823 SPIVEY STATION BLVD STE 360",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362886",
            "telephone_number": "770-741-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "PETRAK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "888-220-6432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paola Cristina Melendez
• Felton L Melton
• Apollo Colintaba Mendoza
• Jasmine Merrell, OTR/L
• Merriment Home Care LLC.
• Valerie R Michael, CADC-II
• Mike Y. Tan, M.D.P.C.
• Toni Miles, RN
• Danielle Miller, CD
• Veronica Yvette Miller, OWNER

• Infectious Disease Physician in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Infectious Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.