NPIMap

Organization Active NPI

Mitchell County Pediatrics Center

  • Pediatrics Physician
  • Camilla, GA
National Provider Identifier
1932288271
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
052162 Issued in GA
Legal business name
MITCHELL COUNTY PEDIATRICS CENTER
Practice address
35 S Scott St
Camilla, GA 31730-1705
Phone
(229) 336-9769
Fax
(229) 336-3867
NPI assigned
Nov 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bashiru A Dawodu, M.D.NPI 1093733305
Title
Owner
Phone
(229) 336-9769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 052162 GA Primary

Addresses

Primary practice location

35 S Scott St
Camilla, GA 31730-1705

Mailing address

35 S Scott St
Camilla, GA 31730-1705
Phone (229) 336-9769

Other identifiers 2

IdentifierTypeStateIssuer
341793MedicaidGA
340537MedicaidGA

National Provider Directory

National Provider Directory

Locations

35 S Scott St
Camilla, GA 31730
Phone (229) 336-9769

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932288271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 S SCOTT ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301705",
            "telephone_number": "229-336-9769",
            "fax_number": "229-336-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 S SCOTT ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301705",
            "telephone_number": "229-336-9769",
            "fax_number": "229-336-3867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL COUNTY PEDIATRICS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAWODU",
        "authorized_official_first_name": "BASHIRU",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-336-9769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "052162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341793",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340537",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camilla, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.