Active NPI
Domonique Charles, M.D.
- Pediatrics Physician
- Macon, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 081118
- Practice address
- 744 1St St
Macon, GA 31201 - Phone
- (478) 633-7600
- NPI assigned
- May 20, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 081118 | GA | Primary |
Addresses
Primary practice location
744 1St St
Macon, GA 31201
Mailing address
744 1St St
Macon, GA 31201-6840
Phone (478) 633-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, VI, DC, AR, NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 5
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Morehouse School of Medicine, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
18670 Graphics Dr
Suite 200
Tinley Park, IL 60477-4605
225 E Washington Ave
Jonesboro, AR 72401-3111
455 Saint Michaels Dr
Santa Fe, NM 87505-7663
6100 Waterford District Dr
Suite 450
Miami, FL 33126-2037
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 081118 | GA | MD | Pediatrics Physician |
| 007709 | GA | MD | Anesthesiologist Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital | Current | Accepting new patients | |
| St Bernards Hospital Inc. | Current | Accepting new patients | |
| Children'S Hospital | Pediatrics | Current | Accepting new patients |
| Governor Juan F. Luis Hospital & Medical Center | Current | Accepting new patients | |
| Governor Juan F. Luis Hospital & Medical Center | Current | Accepting new patients | |
| Children'S Hospital | Current | Accepting new patients | |
| Southeast Iowa Regional Medical Center, Inc. | Past | Accepting new patients |
Locations
1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440
225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630
111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670
2101 Martin Luther King Jr Ave SE
Washington, DC 20020
Phone (202) 476-3670
4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423
Organizations & group practices 8
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.
-
- Children's Hospital
- Washington, DC
- NPI 1912939703
-
- General Acute Care Hospital
- Christiansted, St. Croix, VI
- NPI 1972503647
-
- General Acute Care Hospital
- Jonesboro, AR
- NPI 1396053096
-
- Pediatrics Physician
- Santa Fe, NM
- NPI 1063367803
-
- Community/Retail Pharmacy
- Silver Spring, MD
- NPI 1326878349
-
- Pediatrics Physician
- Washington, DC
- NPI 1780800128
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- St Croix, VI
- NPI 1740238534
-
- General Acute Care Hospital
- West Burlington, IA
- NPI 1134168263
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1932588233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 1ST ST",
"city": "MACON",
"state": "GA",
"postal_code": "312016840",
"telephone_number": "478-633-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "744 1ST ST",
"city": "MACON",
"state": "GA",
"postal_code": "31201",
"telephone_number": "478-633-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLES",
"first_name": "DOMONIQUE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-20",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "081118",
"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 Aug 21, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.