Ayesha Mejia Nettles, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

90111 Issued in GA

Practice address

6600 Van Aalst Blvd BLDG 9250
Fort Moore, GA 31905-2102

Phone

(762) 408-2273

Fax

(762) 408-8101

NPI assigned

May 19, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Associates of Auburn

  • Pediatric Adolescent Medicine Physician
  • Opelika, AL
  • NPI 1316099203
  NPD (past)
• The East Alabama Health Care Authority

  • General Acute Care Hospital
  • Opelika, AL
  • NPI 1154386431
  NPD (past)

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

{
    "created_epoch": "1337385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1871853226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 FITZSIMMONS DR",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD BLDG 9250",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-2273",
            "fax_number": "762-408-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "AYESHA",
        "middle_name": "MEJIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-19",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "90111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ross Murphy
• Ryann Mae Murphy
• Meredith Myatt, NP STUDENT
• Radhakrishnan Narasimhan, M.D.
• Jennifer Suzanne Neal, OTR/L
• Ronald Lee Newcomb Jr., D.O.
• Chad Norton, DO
• Vikki Alisha Nunnery, DNP
• Thomas Alexander O'Hara, DO
• Etinosa Obadagbonyi

• Pediatrics Physician in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.