Jack R Eades, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

043360 Issued in GA

Practice address

6501 Peake Rd Ste 1000
Macon, GA 31210-8052

Phone

(478) 607-2514

Fax

(478) 607-2513

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jackeades@scmgllc.allscriptsdirect.net

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.

• Langford Allergy LLC

  • Allergy & Immunology Physician
  • Macon, GA
  • NPI 1215351291
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Southern Allergy & Asthma, PC

  • Allergy & Immunology Physician
  • Pooler, GA
  • NPI 1538529631
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1992890727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 PEAKE RD STE 1000",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312108052",
            "telephone_number": "478-607-2514",
            "fax_number": "478-607-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 PEAKE RD STE 1000",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312108052",
            "telephone_number": "478-607-2514",
            "fax_number": "478-607-2513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3747 Roswell Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300626227",
            "country_code": "US",
            "telephone_number": "470-956-9050",
            "fax_number": "678-560-4339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EADES",
        "first_name": "JACK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-05-17",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "SC",
            "license": "20053",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "GA",
            "license": "043360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00751264D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00751264F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G43360",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00751264E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Miller Dyes, CPNP-AC/PC
• Heather Miranda Dykes, NP-C
• Lauren Mathews Dykes, NP-C
• Megan White Dykes
• Patrick Steven Dziedzic, PT
• Ear Dynamics, Inc.
• Adrienne Kathleen Earl, NP-C
• Meagan Earl
• Julian M Earls Jr., M.D.
• Pamela Denise Earls, OD

• Allergy & Immunology Physician in Macon, GA
• Providers in Macon, GA by specialty
• Allergy & Immunology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.