Look up the most recent NPI and PECOS records

Mesiah O'Mar Porter

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1611 Satellite Blvd Ste 3, Duluth, GA 30097-4913

PECOS Enrollment

This provider is enrolled in PECOS as MESIAH PORTER.

Based on the most recent information from CMS, provider Mesiah O'Mar Porter is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:24 AM.

Profile Details

Provider ID
1134783368
Provider Type
Individual
Full Name
Porter, Mesiah O'Mar
Title
Mr.

Gender
Male
Sole Proprietor
No
Enumeration Date
4/23/2019
Last Updated
4/23/2019

Contact Information

Practice Location

1611 Satellite Blvd Ste 3, Duluth, GA 30097-4913

(770) 614-6266

(770) 623-9949

Mailing Location

3085 Bentwood Dr, Waycross, GA 31503-4117

(912) 288-1024

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 83-1469962 Georgia

Provider Identifiers

ID	Description	Issuer
ID RN242562	Description Other	Issuer GEORGIA PROFESSIONAL LICENSING Georgia
ID 2018003411	Description Other	Issuer AMERICAN NURSES CREDENTIALING CENTER Georgia

Mesiah O'Mar Porter

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

White, Mosesal Zakia

Sharova, Yelena

Jackson, Bridgitte L.

Nelson, Amanda Smith

Stage, Monique Jennifer

Campbell, Simone Yolanda

Rupani, Mohsin

Mahachi, Nelliah

Fairley, Hannah Degrange

Calloway, Nancy