MACON MEDICAL CLINIC, LLC. (NPI# 1063823482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063823482 |
| Entity Type | Organization |
| Organization Name | MACON MEDICAL CLINIC, LLC. |
| Practice Address |
3350 Northside Dr Macon GA 31210-2504 |
| Practice Telephone | 4784052121 |
| Practice Fax Number | 4784050114 |
| Mailing Telephone | 4784052121 |
| Mailing Fax Number | 4784050114 |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |
| Authorized Official Name | DR. MOHAMMAD MOHABUBUR RAHMAN (PROVIDER/PHYSICIAN/OWNER) |
| Authorized Official Telephone | 4784052121 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
044065 | GA | Ambulatory Health Care Facilities |
| N | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
044065 | GA | Ambulatory Health Care Facilities |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
044065 | GA | Ambulatory Health Care Facilities |
| Street Address |
3350 NORTHSIDE DR |
| City | MACON |
| State | GA |
| Zip Code | 31210-2504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063515815 | Mohammad Mohabubur Rahman | Internal Medicine | 3350 Northside Dr, Macon, GA 31210 | 2006-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649788191 | Quad/med, LLC | Clinic/Center | 3030 Airport E Drive, Macon, GA 31216-7984 | 2018-01-18 |
| 1225551328 | Southern Primary Care, LLC | Clinic/Center | 6501 Peake Rd Ste 400, Macon, GA 31210-8046 | 2017-07-20 |
| 1366715161 | Arimah Medical Inc. | Clinic/Center | 6501 Peake Rd Bldg 900, Macon, GA 31210 | 2012-02-10 |
| 1689826315 | Maria Cavaliere LLC | Clinic/Center | 310 Hospital Dr Bldg B, Suite 300, Macon, GA 31217-3895 | 2008-10-14 |
| 1861894495 | Enterprise Family Healthcare | Clinic/Center | 2192 Ingleside Ave, Macon, GA 31204-2030 | 2014-09-26 |
| 1578999033 | Robert C Jones Md LLC | Clinic/Center | 3200 Riverside Dr, Ste B300, Macon, GA 31210-2550 | 2013-09-16 |
| 1245506377 | Crawford Mobile Health Clinic | Clinic/Center | 15865 Highway 14 West, Macon, MS 39341-0402 | 2012-03-22 |
| 1760668586 | Enterprise Family Healthcare | Clinic/Center | 2192 Ingleside Ave, Macon, GA 31204-2030 | 2008-01-10 |
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| 1619575834 | The Iv Spot, LLC. | Clinic/Center | 2100 Parklake Dr Ne # C-5, Atlanta, GA 30345-2824 | 2020-10-09 |
| 1528673514 | Safe Haven Medical Services | Clinic/Center | 444 Racetrack Rd, Mcdonough, GA 30252-6837 | 2020-09-15 |
| 1780296533 | North Atlanta Mental Wellness | Clinic/Center | 1742 Mount Vernon Rd Ste 150b, Atlanta, GA 30338-4251 | 2020-08-21 |
| 1639788136 | Walker Health and Wellness LLC | Clinic/Center | 111 Bradford Dr, Bloomingdale, GA 31302-4926 | 2020-07-30 |
| 1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
| 1598389637 | Mercie Health | Clinic/Center | 3721 New Macland Rd Ste 246, Powder Springs, GA 30127-2000 | 2020-06-04 |
| 1366061699 | Beyondmed LLC | Clinic/Center | 1820 Willow Branch Ln Nw, Kennesaw, GA 30152-4558 | 2020-04-16 |
| 1366082596 | Rock Health Inc | Clinic/Center | 5385 Five Forks Trickum Rd Ste F, Stone Mountain, GA 30087-3018 | 2020-01-15 |
| 1477192219 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 5163 Thompson Bridge Rd, Murrayville, GA 30564-1930 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.