CHILDRENS MEDICAL CENTER (NPI# 1154485415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154485415 |
| Entity Type | Organization |
| Organization Name | CHILDRENS MEDICAL CENTER |
| Practice Address |
5488 N Alabama Ave Omega GA 31775-3054 |
| Mailing Address |
Po Box 7627 Tifton GA 31793-7627 |
| Practice Telephone | 2295284546 |
| Practice Fax Number | 2295284841 |
| Mailing Telephone | 2293965830 |
| Mailing Fax Number | 2293913686 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2013-03-26 |
| Authorized Official Name | CLYDE GRANVILLE SIMMONS (CEO) |
| Authorized Official Telephone | 2295284546 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629238456 | Childrens Medical Center | Special Hospital | 1800 Rice Mine Rd N, Tuscaloosa, AL 35406-2383 | 2008-06-16 |
| 1710034376 | Childrens Medical Center | Exclusive Provider Organization | 4651 Sheridan St, Suite 270, Hollywood, FL 33021-3457 | 2007-01-05 |
| 1881763068 | Childrens Medical Center | Specialist | 131 Commonwealth Dr, Suite 310, Greenville, SC 29615-4883 | 2006-11-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CHILDRENS MEDICAL CENTER OF TUCSON | 5861 N Oracle Rd, Tucson, AZ 85704-3813 |
| Street Address |
5488 N ALABAMA AVE |
| City | OMEGA |
| State | GA |
| Zip Code | 31775-3054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609866938 | John T. Eanes II | Pediatrics | 5488 N Alabama Ave, Omega, GA 31775-3054 | 2005-10-27 |
| 1033173570 | Pamela C. Collier | Nurse Practitioner | 5488 N Alabama Ave, Omega, GA 31775-3054 | 2006-04-13 |
| 1235193582 | Clyde G Simmons | Specialist | 5488 N Alabama Ave, Omega, GA 31775-3054 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518057645 | Robert C Bowman | Family Medicine | 130 Moore St, Omega, GA 31775-3075 | 2006-10-12 |
| 1073140927 | Premiercare Omega | Family Medicine | 130 Moore St, Omega, GA 31775-3075 | 2020-03-23 |
| 1982111704 | Carroll Davis Jackson | Nurse Practitioner | 130 Moore St, Omega, GA 31775-3075 | 2018-01-02 |
| 1184021933 | Omega Family Medicine, LLC | Family Medicine | 130 Moore St, Omega, GA 31775-3075 | 2014-11-21 |
| 1699915868 | Richard Glen Baker | Nurse Practitioner | 130 Moore St, Omega, GA 31775-3075 | 2009-03-02 |
| 1396709507 | Omega Pharmacy LLC | Pharmacy | 246 Oak St, Omega, GA 31775-3087 | 2006-04-14 |
| 1164058566 | Lauren Lindsey | Pharmacist | 246 Oak St, Omega, GA 31775-3087 | 2020-03-17 |
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235193582 | Clyde G Simmons | Specialist | 5488 N Alabama Ave, Omega, GA 31775-3054 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113718 | Jennifer Lynn Harper | Specialist | 46 Rice Lewis Gilliard Dr, Toccoa, GA 30577-3683 | 2020-10-30 |
| 1265030407 | Sandra W Paul | Specialist | 4185 Glad Morning Dr, Atlanta, GA 30349-3902 | 2020-10-10 |
| 1851907992 | Diana Rowe | Specialist | 35 Homeplace Dr, Covington, GA 30016-8539 | 2020-09-23 |
| 1053926154 | Idoc Virtual Neuro Critical Care LLC | Specialist | 159 E Wesley Rd Ne, Atlanta, GA 30305-3707 | 2020-09-15 |
| 1649885179 | Rakiya Parker | Specialist | 4814 Stone Mountain Hwy Ste 9, Lilburn, GA 30047-4649 | 2020-09-11 |
| 1649888785 | Valeria Kim West | Specialist | 204 W Oglethorpe Hwy, Hinesville, GA 31313-3615 | 2020-07-15 |
| 1225658511 | Louis P Towles IIi | Specialist | 755 Commerce Dr Ste 600, Decatur, GA 30030-2619 | 2020-04-16 |
| 1316566755 | Kindle-simone Friedlander | Specialist | 13988 Sunfish Bnd, Alpharetta, GA 30004-0605 | 2020-04-15 |
| 1184252595 | Peachtree Surgical Assistants Inc | Specialist | 59 Anderson Ave Apt 127, Canton, GA 30114-2330 | 2020-03-31 |
| 1164056859 | Bimal R Shah Md PC | Specialist | 820 Saint Sebastian Way Ste 2a, Augusta, GA 30901-2636 | 2020-03-03 |
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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.