MOULTRIE MEDICAL PC
NPI 1215618640
Clinic/Center - Primary Care in Brookhaven, GA
About Moultrie Medical Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MOULTRIE MEDICAL PC (NPI 1215618640) is a healthcare organization registered as a primary care in Brookhaven, Georgia and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through September 26, 2027 and lists John Moultrie, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Moultrie Medical Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Moultrie Medical PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Sandy Springs, GA 30328
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2290537
Moultrie Medical PC · Brookhaven, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Moultrie Medical PC's NPI number?
The NPI number for Moultrie Medical PC is 1215618640. It was assigned to this organization in the NPPES registry on July 27, 2023.
Where is Moultrie Medical PC located?
Moultrie Medical PC is located at 2970 Clairmont Rd NE Ste 210, Brookhaven, GA 30329. The listed phone number is (256) 302-3505.
What is Moultrie Medical PC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Moultrie Medical PC enrolled in Medicare?
Yes. Moultrie Medical PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Moultrie Medical PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Moultrie Medical PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Moultrie Medical PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2290537) is associated with this NPI, valid through September 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Moultrie Medical PC was last updated on July 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Moultrie Medical Pc · NPI 1215618640
Primary Care organization in Brookhaven, Georgia. Organization record, active in the CMS NPPES registry since July 27, 2023.
## Identity
- **NPI:** 1215618640 (Entity type: Organization)
- **Enumerated:** July 27, 2023
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** John Moultrie, OWNER
## Practice location
- **Address:** 2970 CLAIRMONT RD NE STE 210, Brookhaven, GA 30329-4414
- **Phone:** (256) 302-3505
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 27, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215618640) · Data from the CMS NPPES public registry.