DR. MARY TANEOUS (NPI# 1013984780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013984780 |
| Entity Type | Individual |
| Full Name | DR. MARY TANEOUS |
| Credential | MD |
| Practice Address |
1350 Walton Way Augusta GA 30901-2612 |
| Mailing Address |
14275 Midway Rd Suite 400 Addison TX 75001-3614 |
| Practice Telephone | 7067745400 |
| Practice Fax Number | 7067745096 |
| Mailing Telephone | 3172758000 |
| Mailing Fax Number | 6102714245 |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2015-07-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
000346 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 838631566A | 05 | |
| GA | TRICARE | 58-1446543-001 | 01 |
| GA | BCBS | 52212128 | 01 |
| Street Address |
1350 WALTON WAY |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30901-2612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811993926 | Mary Jo Goolsby | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2005-06-23 |
| 1750989810 | Trang Khanh Nguyen | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2629 | 2020-10-12 |
| 1245842152 | Margaret Anne Rossi | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-08-21 |
| 1003445313 | Sarika Mishra | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-04-07 |
| 1508491812 | Kyle Guderian | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-03-06 |
| 1982246070 | Aisha Ford | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-10-10 |
| 1588214977 | Alexander S Elsen | Physical Medicine & Rehabilitation | 1350 Walton Way, Augusta, GA 30901-2629 | 2019-09-17 |
| 1215599527 | Sherwin Goering | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-07-08 |
| 1417418807 | Christopher Brandon Walker | Student in an Organized Health Care Education/Training Program | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-03-27 |
| 1205309333 | Rachel Ann Shaver | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2629 | 2019-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477019925 | Courtney Erin Fairchild | Physician Assistant | 1101 15th Street, Pa-224, Augusta, GA 30901 | 2019-02-20 |
| 1699263921 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1022 Walton Way Spc C, Augusta, GA 30901 | 2018-04-23 |
| 1235684192 | Heather Raborn | Allergy & Immunology | 1350 Walton Way Ste 5100, Augusta, GA 30901 | 2016-08-22 |
| 1457690745 | Rehab Without Walls, Inc. | In Home Supportive Care | 820 St Sebastin Way Se, Augusta, GA 30901 | 2013-02-06 |
| 1861788051 | Christina Weidner Belcher | Physical Therapist | 1246 Pine St, Augusta, GA 30901 | 2011-06-25 |
| 1750695979 | C H Martin Company | Durable Medical Equipment & Medical Supplies | 1456 Walton Way Suite B, Augusta, GA 30901 | 2010-07-29 |
| 1366773905 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4027 Wheeler Rd, Augusta, GA 30901 | 2010-01-21 |
| 1851622484 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1715 Forest Drive, Augusta, GA 30901 | 2010-01-21 |
| 1760615280 | Absolute Family PCh | Point of Service | 2035 Old Savannah Rd., Augusta, GA 30901 | 2009-09-01 |
| 1073740643 | Ryan J Altenburg | Internal Medicine | 820 Saint Sebastian Way Ste 8a, Augusta, GA 30901 | 2009-06-22 |
| Find all providers in zip 30901 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255957148 | Thomas E Cotter | Pathology | 1120 15th St # Bf-103b, Augusta, GA 30912-0004 | 2020-06-17 |
| 1386269835 | Pramila Pallikkappara Moideen | Pathology | Augusta University Medical Center Room Bf-103-b, Augusta, GA 30912-0001 | 2020-06-10 |
| 1720200306 | Scott Christopher Drury | Pathology | 2638 Coventry Rd, Augusta, GA 30909-6106 | 2007-05-03 |
| 1417000100 | Alvin B Bryan Jr. | Pathology | 1520 N Leg Rd, Augusta, GA 30909-4332 | 2007-01-18 |
| 1972686749 | David L Booker | Pathology | 1462 Laney Walker Blvd, Ca-2105, Augusta, GA 30912-0003 | 2006-10-23 |
| 1356379127 | Charles Beacham | Pathology | 3505 Lost Tree Ln, Augusta, GA 30907-9516 | 2006-06-29 |
| 1912948050 | Mark David Gusack | Pathology | 1 Center St, Augusta, ME 04330-6410 | 2006-06-09 |
| 1730173493 | Dwight Paul Mirmow | Pathology | 2260 Lurightsboro Rd, Laboratory Medicine, PC, Augusta, GA 30904 | 2005-09-08 |
| 1861018772 | Kiran Madwani | Pathology | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-17 |
| 1669097770 | Nivin Omar | Pathology | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-15 |
| Find all providers in AUGUSTA | ||||
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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.