Moultrie Urological Clinic, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

031557 Issued in GA

Legal business name

MOULTRIE UROLOGICAL CLINIC, INC

Practice address

2 Hospital Park
Moultrie, GA 31768-6700

Phone

(229) 985-3066

Fax

(229) 890-2092

NPI assigned

Jun 8, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Maha Kassis Baddour, RMM, MBA

Title

Practice Manager

Phone

(229) 985-3066

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269388800000",
    "number": "1861695579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686700",
            "telephone_number": "229-985-3066",
            "fax_number": "229-890-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686700",
            "telephone_number": "229-985-3066",
            "fax_number": "229-890-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE UROLOGICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2010-03-24",
        "status": "A",
        "authorized_official_last_name": "BADDOUR",
        "authorized_official_first_name": "MAHA",
        "authorized_official_middle_name": "KASSIS",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "229-985-3066",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RMM, MBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "031557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00400518A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; 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.