Azalea Center for Plastic Surgery PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

39418 Issued in GA

Legal business name

AZALEA CENTER FOR PLASTIC SURGERY PC

Practice address

2810 N Oak St
Valdosta, GA 31602-1716

Phone

(229) 259-0019

Fax

(229) 259-0209

NPI assigned

Mar 6, 2007

Last updated

Feb 6, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bridgett Moore, MDNPI 1679764757

Title

Medical Director

Phone

(229) 259-0019

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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.

• Bridgett Moore, M.D.

  • Specialist
  • Valdosta, GA
  • NPI 1679764757
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1952431223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021716",
            "telephone_number": "229-259-0019",
            "fax_number": "229-259-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021716",
            "telephone_number": "229-259-0019",
            "fax_number": "229-259-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZALEA CENTER FOR PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BRIDGETT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "229-259-0019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "39418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PROVIDER #",
            "identifier": "110206439",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00830277A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "511G700695",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GA PROVIDER #",
            "identifier": "598880",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra M. Avellaneda, LMHC, LPC
• Curtis Lamar Avera, AA
• Shalese Aycock, NP
• Musa Ayyad, MD, DC
• Azalea Behavioral Services LLC
• Azalea City Chiropractic
• Azalea City Family Dentistry
• Azalea Neuro and Spine Clinic PC
• Azalea Rehab Services, LLC
• Azalea Sleep Labs, Inc.

• Specialist in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.