MACKLANDER, LLC (NPI# 1801134739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801134739 |
| Entity Type | Organization |
| Organization Name | MACKLANDER, LLC |
| Other Organization Name | MACKSIMUM ALLIANCE |
| Practice Address |
1514 Baldwin Lakes Dr Grovetown GA 30813-5887 |
| Practice Telephone | 7068540555 |
| Practice Fax Number | 7066519677 |
| Mailing Telephone | 7068540555 |
| Mailing Fax Number | 7066519677 |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2013-01-28 |
| Authorized Official Name | MRS. SHELLEY DIANE MACK (ADMINISTRATOR) |
| Authorized Official Telephone | 7068540555 |
| Is Organization Subpart | Y |
| Parent Organization Name | MACKLANDER, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251J00000X | Nursing Care | 036-R-0525 | GA | Agencies |
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
036-R-0525 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 366878280B | 05 | |
| GA | 366878280A | 05 |
| Other Name | Type Code |
|---|---|
| Macksimum Alliance | Doing Business As Name - Organization |
| Street Address |
1514 BALDWIN LAKES DR |
| City | GROVETOWN |
| State | GA |
| Zip Code | 30813-5887 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134435092 | Shelley Diane Mack | Chore Provider | 1514 Baldwin Lakes Dr, Grovetown, GA 30813-5887 | 2010-08-29 |
| 1316285315 | Lizzy's Adult Community Service Center | Clinic/Center | 1514 Baldwin Lakes Dr, Grovetown, GA 30813-5887 | 2013-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598276412 | Georgia Dental Professionals, PC | Dentist | 9596 Bentley Dr., Grovetown, GA 30813 | 2017-10-18 |
| 1558891895 | Jennifer M Humm | Dentist | 250 Merridian Drive, Grovetown, GA 30813 | 2017-06-19 |
| 1710335443 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 435 Lewiston Rd, Grovetown, GA 30813 | 2016-06-03 |
| 1558727214 | Lynda R Green | Counselor | 426 Northrop Place, Grovetown, GA 30813 | 2016-01-11 |
| 1689002610 | Patriots Park Dental, LLC | Dentist | 701 Devika Drive, Ste 10, Grovetown, GA 30813 | 2013-10-30 |
| 1255680096 | David Schulte Jr. | Internal Medicine | 925 Branch Ct Ste 2101, Grovetown, GA 30813 | 2012-09-07 |
| 1548519481 | Ashley Roberts Saunders | Pharmacist | 869 Horizon South Parkway, Grovetown, GA 30813 | 2012-09-06 |
| 1447569694 | Wallace Allen Partridge Jr. | Pharmacist | 5104 Wrightsboro Rd., Fred's Pharmacy 1699, Grovetown, GA 30813 | 2010-10-05 |
| 1497908149 | Sharon M Blair | Registered Nurse | 7640 Pleasantville Way, Grovetown, GA 30813 | 2008-10-28 |
| 1710160791 | Rebecca Meek | Nurse Practitioner | 469 Lewiston Rd, Grovetown, GA 30813 | 2007-12-12 |
| Find all providers in zip 30813 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922653534 | Five Star Education Advocacy Group Inc | Clinic/Center | 978 Fellowship Rd, Fairburn, GA 30213-1789 | 2019-08-09 |
| 1205329687 | Advantage Behavioral Health Systems | Clinic/Center | 638 Michael Cir., Monroe, GA 30655 | 2018-06-11 |
| 1215420690 | Advantage Behavioral Health Systems | Clinic/Center | 1801 Prospect Rd., Madison, GA 30650 | 2018-06-11 |
| 1285149955 | Alicia Gordon | Clinic/Center | 132 Carol Cir, Fitzgerald, GA 31750-8128 | 2017-12-04 |
| 1225567597 | Vincentia Paul-constantin | Clinic/Center | 2867 Country House Lane, Buford, GA 30519 | 2017-06-08 |
| 1598158909 | Musik To Grow | Clinic/Center | 1517 Johnson Ferry Rd, Marietta, GA 30062-6493 | 2015-03-09 |
| 1356692800 | Ridgewood Personal Care Home, Inc | Clinic/Center | 1065 Murray Cir Sw, Marietta, GA 30064-3927 | 2012-09-24 |
| 1790055432 | Trapeze Therapy, LLC | Clinic/Center | 160 Tracy St, Suite A, Athens, GA 30601-1979 | 2012-01-11 |
| 1326316274 | Early/miller Day (now) | Clinic/Center | 302 Damacus Street, Blakely, GA 39823-3346 | 2011-12-07 |
| 1710255773 | Early Miller Personal Support (now) | Clinic/Center | 302 Damascus Street, Blakely, GA 39823-3346 | 2011-12-06 |
| 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.