Medical Escort LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MEDICAL ESCORT LLC

Practice address

229 Rugged Creek Dr
Stockbridge, GA 30281-4568

Phone

(404) 617-5301

NPI assigned

Dec 8, 2023

Organization subpart

No

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

Authorized official

Name

Andre Haynes

Title

Medical Director

Phone

(404) 617-5301

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1701993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1861269995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 RUGGED CREEK DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 RUGGED CREEK DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814568",
            "telephone_number": "404-617-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ESCORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-617-5301"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Stockbridge, GA
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• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.