Individual provider Active NPI

Domonique Charles, M.D.

  • Pediatrics Physician
  • Macon, GA
National Provider Identifier
1932588233
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
081118 Issued in GA
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

Updated by the provider on Aug 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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, NM5 enrollments
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 5

Enrollment IDStateProvider typePAC IDDetails
I20181204001090 GA Practitioner - Pediatric Medicine 0345543906
I20241231002062 VI Practitioner - Pediatric Medicine 0345543906 Reassigns benefits to 1 organization
I20250318001871 DC Practitioner - Pediatric Medicine 0345543906 Reassigns benefits to 1 organization
I20251126001846 AR Practitioner - Pediatric Medicine 0345543906 Reassigns benefits to 1 organization
I20260622001390 NM Practitioner - Pediatric MedicinePractitioner - Hospitalist 0345543906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Hospitalist
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

LicenseStateTypeSpecialty
081118GAMDPediatrics Physician
007709GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Current Accepting new patients
St Bernards Hospital Inc. CurrentSince Dec 1, 2025 Accepting new patients
Children'S Hospital Pediatrics CurrentSince Feb 7, 2025 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Dec 11, 2024 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Dec 11, 2024 Accepting new patients
Children'S Hospital CurrentSince Feb 7, 2025 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.

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

Verify at the official NPI Registry.