Organization
MALDONADO & MORENO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY WASHINGTON (BILLING)
(770) 775-4622
Entity
Organization
Contact information
Practice address
375 MCDONOUGH RD, JACKSON, GA 30233-1509
(770) 775-4622
Mailing address
375 MCDONOUGH RD, JACKSON, GA 30233-1509
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
022255
GA
207Q00000X
Family Medicine Physician
Primary
046792
GA
225X00000X
Occupational Therapist
OT002221
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000211549A
—
GA
05
—
000885024A
—
GA
05
—
555980929C
—
GA
01
—
GRP4245
MEDICARE GROUP #
GA
Enumeration date
02/08/2007
Last updated
04/10/2015
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