Provider Demographics
NPI:1508085135
Name:ANDREW T MECCA MD PC
Entity Type:Organization
Organization Name:ANDREW T MECCA MD PC
Other - Org Name:MEDCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:MECCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-322-2223
Mailing Address - Street 1:5612 WHITESVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9031
Mailing Address - Country:US
Mailing Address - Phone:706-322-2223
Mailing Address - Fax:706-324-5233
Practice Address - Street 1:5612 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9031
Practice Address - Country:US
Practice Address - Phone:706-322-2223
Practice Address - Fax:706-324-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000540196AMedicaid
GAF49309Medicare UPIN