Jared Mugabe Kiddoe, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2012-01144 Issued in NC

Practice address

200 McGee Rd
Anderson, SC 29625-2104

Phone

(828) 651-6593

NPI assigned

May 27, 2008

Last updated

Mar 25, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Specialty

Psychiatry

Education

Duke University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Jared Kiddoe MD Professional Corporation

  dba Authentic Wellness Group

  • Child & Adolescent Psychiatry Physician
  • Suwanee, GA
  • NPI 1437097003
  NPD Authorized official

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1972761047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MCGEE RD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296252104",
            "telephone_number": "864-260-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MCGEE RD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296252104",
            "telephone_number": "828-651-6593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1070 Swan Mill Ct",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300242819",
            "country_code": "US",
            "telephone_number": "919-666-8546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDDOE",
        "first_name": "JARED",
        "middle_name": "MUGABE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "SC",
            "license": "91644",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME114778",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "2012-01144",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2012-01144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3650 Steve Reynolds Blvd",
            "city": "Duluth",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300964506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tanishia N Kessley
• Kevin Nietzer DMD PA (Anderson Pediatric Dentistry PA)
• Khizar Khan, MD
• Irakli Khulordava, M.D.
• Hui-Tzu M Kiang, DO
• Alison Kill, OTR/L
• Amy L Kilpatrick
• Raymond Kimball, M.D.
• Christen Michelle King
• Kimberly M. King, MD

• Psychiatry Physician in Anderson, SC
• Providers in Anderson, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; 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.

Verify at the official NPI Registry.