Individual provider Active NPI

Jennifer Bo Ling Yu-Datta, MD

  • Family Medicine Physician
  • Macon, GA
National Provider Identifier
1841877917
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
99990 Issued in GA
Practice address
777 Hemlock St # 165
Macon, GA 31201-2102
Phone
(478) 633-1000
NPI assigned
Mar 25, 2021
Last updated
Jul 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 13431 GA
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 99990 GA Primary

Addresses

Primary practice location

777 Hemlock St # 165
Macon, GA 31201-2102

Mailing address

777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-1000

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
I20240819001150 GA Practitioner - Family Practice 9133523715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cogent Healthcare of Macon, LLCGroup PAC ID 9234104019, 73 clinicians

Practice addresses (Care Compare)

777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-7444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13431GAMDGeneral Practice Dentistry
99990GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Macon, LLC Family Medicine CurrentSince Jun 1, 2024 Accepting new patients

Locations

777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600

777 Hemlock St
#104
Macon, GA 31201
Phone (478) 633-7550

777 Hemlock St
#165
Macon, GA 31201
Phone (478) 633-1634

Interoperability endpoints

  • Direct secure messaging: dwatanabe447019@carolinashealthcaresystem.direct-ci.com

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 5

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": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1841877917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "478-633-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST # 165",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "478-633-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YU-DATTA",
        "first_name": "JENNIFER",
        "middle_name": "BO LING",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "13431",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "99990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.