NPIMap

Organization Active NPI

OBGYN Specialists

  • Obstetrics Physician
  • Macon, GA
National Provider Identifier
1952406761
Registry record updated Apr 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
Legal business name
OBGYN SPECIALISTS
Practice address
380 Hospital Dr
Suite 100
Macon, GA 31217-8001
Phone
(478) 743-4646
Fax
(478) 742-5549
NPI assigned
Sep 14, 2006
Last updated
Apr 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2014

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

Authorized official

Name
Melanie Black
Title
Office Manager
Phone
(478) 743-4646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics Physician 207VX0000X NU Primary

Addresses

Primary practice location

380 Hospital Dr
Suite 100
Macon, GA 31217-8001

Mailing address

380 Hospital Dr
Suite 100
Macon, GA 31217-8001
Phone (478) 743-4646

Other identifiers 1

IdentifierTypeStateIssuer
300019748AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419000710 GA Part B Supplier - Clinic/Group Practice 2264427228 Receives reassigned benefits from 10 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

380 Hospital Dr
Ste 100
Macon, GA 31217
Phone (478) 743-4646

Practitioners & affiliated clinicians

Practitioners 11

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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397520000000",
    "number": "1952406761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 HOSPITAL DR",
            "address_2": "SUITE 100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178001",
            "telephone_number": "478-743-4646",
            "fax_number": "478-742-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 HOSPITAL DR",
            "address_2": "SUITE 100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178001",
            "telephone_number": "478-743-4646",
            "fax_number": "478-742-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBGYN SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2014-04-15",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "478-743-4646"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300019748A",
            "state": "GA"
        }
    ],
    "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 Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.