Dominique Mack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13682 Issued in GA

Practice address

334 Smith Ave
Thomasville, GA 31792-5533

Phone

(229) 227-1595

NPI assigned

Jan 3, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nique Mack Other name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nephrology Medical Associates of Georgia, LLCGroup PAC ID 5991600629, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Nephrology Medical Associates of Georgia LLC

  • Nephrology Physician
  • Thomasville, GA
  • NPI 1740706951
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778198400000",
    "number": "1992575617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 SMITH AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925533",
            "telephone_number": "229-227-1595",
            "fax_number": "229-227-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 SMITH AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925533",
            "telephone_number": "229-227-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "DOMINIQUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-03",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIQUE",
            "last_name": "MACK",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lisa Dawn Lowe, FNP
• Morgan Lowe
• Sabra Elizabeth Lowe, L.D.
• Ann T Lucas
• Allen R Lybrook, APRN,BC
• Michael J Magbalon, MD
• Christina Maher, DPT
• Rachel Lauren Maher, LAT, ATC
• John A Mansberger
• Catherine Marchant, LCSW

• Physician Assistant in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.