NPIMap

Organization Active NPI

East Clinic LLC

  • Family Medicine Physician
  • Dallas, GA
National Provider Identifier
1831563261
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
63187 Issued in GA
Legal business name
EAST CLINIC LLC
Practice address
539 Hardee St
Dallas, GA 30132-4711
Phone
(770) 505-0531
Fax
(770) 485-0570
NPI assigned
Nov 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

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

Authorized official

Name
Dr. Mary J East, M.D.NPI 1225091341
Title
Owner/Physician
Phone
(770) 505-0531

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 63187 GA Primary

Addresses

Primary practice location

539 Hardee St
Dallas, GA 30132-4711

Mailing address

539 Hardee St
Dallas, GA 30132-4711
Phone (770) 505-0531

Other names 1

  • THE EAST CLINIC, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151215002341 GA Part B Supplier - Clinic/Group Practice 1557662699 Receives reassigned benefits from 1 practitioner
Practice locations: Dallas, GA

National Provider Directory

National Provider Directory

Locations

539 Hardee St
Dallas, GA 30132
Phone (770) 505-0531

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1831563261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 HARDEE ST",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324711",
            "telephone_number": "770-505-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 HARDEE ST",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324711",
            "telephone_number": "770-505-0531",
            "fax_number": "770-485-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-23",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "770-505-0531",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "63187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE EAST CLINIC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; 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.