DORNER LEE CARMICHAEL (NPI# 1265491179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265491179 |
| Entity Type | Individual |
| Full Name | DORNER LEE CARMICHAEL |
| Other Name | DORNER LEE TICE |
| Credential | PA-C |
| Practice Address |
764 Pine St Macon GA 31201-2107 |
| Mailing Address |
598 3rd St Macon GA 31201-3357 |
| Practice Telephone | 4786331696 |
| Practice Fax Number | 4786332316 |
| Mailing Telephone | 4786336706 |
| Mailing Fax Number | 4786335384 |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2015-04-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 000211 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | DEA | MC1021764 | 01 |
| GA | RAIL ROAD MEDICARE | 970011438 | 01 |
| GA | 100001881A | 05 |
| Street Address |
764 PINE ST |
| City | MACON |
| State | GA |
| Zip Code | 31201-2107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629045554 | Gregory Eilers | Family Medicine | 764 Pine St, Macon, GA 31201-2107 | 2006-02-28 |
| 1255996088 | Monae Marie Fennell | Obstetrics & Gynecology | 764 Pine St, Macon, GA 31201-2107 | 2019-05-07 |
| 1346804960 | Sara Beth Leitheiser | Obstetrics & Gynecology | 764 Pine St, Macon, GA 31201-2107 | 2019-04-29 |
| 1336602770 | Gregory Paul Morgan | Internal Medicine | 764 Pine St, Macon, GA 31201 | 2019-04-11 |
| 1356804041 | Sunny Dilipkumar Dattani | Internal Medicine | 764 Pine St, Macon, GA 31201-2107 | 2019-04-09 |
| 1962964320 | Juliet Emily Nonnemacher | Pediatrics | 764 Pine St, Macon, GA 31201-2107 | 2019-04-04 |
| 1447712005 | Mariana Ellington | Obstetrics & Gynecology | 764 Pine St, Macon, GA 31201-2107 | 2019-04-03 |
| 1811459555 | Joa Alexis Allen | Obstetrics & Gynecology | 764 Pine St, Macon, GA 31201-2107 | 2019-04-02 |
| 1780146308 | Nafis Islam | Internal Medicine | 764 Pine St, Macon, GA 31201 | 2019-04-02 |
| 1942762802 | Victoria Walker | Internal Medicine | 764 Pine St, Macon, GA 31201-2107 | 2019-04-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
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| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245854348 | Monica Bruney | Physician Assistant | 101 Preston Ct Ste 103, Macon, GA 31210-5771 | 2020-06-04 |
| 1023677895 | Kathleen Forbes Matthews | Physician Assistant | 3735 Bonita Pl, Macon, GA 31204-1309 | 2019-06-06 |
| 1659773018 | Joseph T. Smoak | Physician Assistant | 4226 Hartley Bridge Road, Suite 104, Macon, GA 31216-4116 | 2014-09-17 |
| 1821439811 | Irene Gung Ho | Physician Assistant | 3203 Vineville Ave Ste A, Macon, GA 31204 | 2013-07-08 |
| 1528235397 | Emmanuel Amwenba Enoghayin | Physician Assistant | 157 Cambridge Way, Macon, GA 31220-8736 | 2008-05-12 |
| 1801000153 | Jennifer L. Hames | Physician Assistant | 771 Orange St, Macon, GA 31201-2126 | 2007-05-09 |
| 1093847840 | Betty Jo Lynn Fancher | Physician Assistant | 3711 Eisenhower Pkwy, Macon, GA 31206-3672 | 2007-03-09 |
| 1659322105 | Christopher B Kelley | Physician Assistant | 201 Oakleaf Dr, Macon, GA 31210-1924 | 2006-05-12 |
| 1275591828 | Delano Parker | Physician Assistant | 1157 Forsyth Street, Macon, GA 31201 | 2006-05-03 |
| 1609869197 | Deborah D Moore | Physician Assistant | 1157 Forsyth St, Macon, GA 31201-7452 | 2005-08-30 |
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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.