MEDICARE: MALDONADO & MORENO, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	022255	GA
2	225X00000X	Occupational Therapist	OT002221	GA
3	207Q00000X	Family Medicine Physician	046792	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	GRP4245	OTHER	GA	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699815340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALDONADO & MORENO, PC

Provider Business Mailing Address
First Line	:	375 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1509
Country	:	US
Telephone Number	:	770-775-4622
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	CATHY WASHINGTON
Credential	:
Telephone Number	:	770-775-4622

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/10/2015

Similar Medicare Providers

1649223587 — SEEMA MORENO O.T.R/L
Practice Location Address:

375 MCDONOUGH RD
JACKSON, GA
30233-1509

Practice Phone: 770-775-4622
Practice Fax: 770-775-4132

1518914597 — JORGE LUIS MORENO JR. M.D.
Practice Location Address:

375 MCDONOUGH RD
JACKSON, GA
30233-1509

Practice Phone: 770-775-4622
Practice Fax: 770-775-4132

1518904242 — DR. JORGE LUIS MORENO SR. M.D.
Practice Location Address:

375 MCDONOUGH RD
JACKSON, GA
30233-1509

Practice Phone: 770-775-4622
Practice Fax: 770-775-4132

1982692422 — RICKIE D DESCAMPS DO
Practice Location Address:

1509 W JACKSON ST
KNOXVILLE, IA
50138-1008

Practice Phone: 641-828-7556
Practice Fax:

1417106667 — GLORYE WOOL. M.D. S. C.
Practice Location Address:

53 W JACKSON BLVD , 1509
CHICAGO, IL
60604-3606

Practice Phone: 312-786-1426
Practice Fax:

1760151740 — BENCHMARK PHYSICAL THERAPY OF MISSISSIPPI LLC
Practice Location Address:

1509 JACKSON AVE
PASCAGOULA, MS
39567-4356

Practice Phone: 228-220-1600
Practice Fax: 228-284-1687

Directions to “MALDONADO & MORENO, PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.