Active NPI
Michael Loraditch, PA
- Physician Assistant
- Macon, GA
National Provider Identifier
1912917642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 002049
- Practice address
- 777 Hemlock St
Hospital Box 64
Macon, GA 31201-2102 - Phone
- (478) 633-2097
- Fax
- (478) 633-7836
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002049 | GA | Primary |
Addresses
Primary practice location
777 Hemlock St
Hospital Box 64
Macon, GA 31201-2102
Mailing address
103 Waldorf Dr
Perry, GA 31069-8741
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2049 | GA | MD | Clinical Social Worker |
| 002049 | GA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912917642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 WALDORF DR",
"city": "PERRY",
"state": "GA",
"postal_code": "310698741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 HEMLOCK ST",
"address_2": "HOSPITAL BOX 64",
"city": "MACON",
"state": "GA",
"postal_code": "312012102",
"telephone_number": "478-633-2097",
"fax_number": "478-633-7836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORADITCH",
"first_name": "MICHAEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "002049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.