| Sgmc Physician Network Inc | |
|
2501 N Patterson St Valdosta GA 31602-1735 | |
| (229) 433-1997 | |
| (229) 433-1998 |
| Full Name | Sgmc Physician Network Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 N Patterson St, Valdosta, Georgia |
| Authorized Official Name and Position | Julie Hodges (CONTROLLER) |
| Authorized Official Contact | 2292594140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sgmc Physician Network Inc Po Box 9 Valdosta GA 31603-0009 Ph: (229) 245-6232 | Sgmc Physician Network Inc 2501 N Patterson St Valdosta GA 31602-1735 Ph: (229) 433-1997 |
| NPI Number | 1417597170 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 07/28/2022 |
| Medicare PECOS PAC ID | 4082036843 |
|---|---|
| Medicare Enrollment ID | O20201015000629 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417597170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | David R Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215079983 PECOS PAC ID: 8325937956 Enrollment ID: I20040312000173 |
| Provider Name | James C. Eutzler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801887161 PECOS PAC ID: 9931192986 Enrollment ID: I20040406000253 |
| Provider Name | William N Oduro |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720177488 PECOS PAC ID: 5294716007 Enrollment ID: I20040527000559 |
| Provider Name | Leonard F Howard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841227923 PECOS PAC ID: 0244212207 Enrollment ID: I20040603000361 |
| Provider Name | Joe H Johnson |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1326082033 PECOS PAC ID: 8022919505 Enrollment ID: I20040622000832 |
| Provider Name | Randall B Brown |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1124062831 PECOS PAC ID: 2668373143 Enrollment ID: I20040622001088 |
| Provider Name | Robert D Collins |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1447250220 PECOS PAC ID: 6901882182 Enrollment ID: I20040628001126 |
| Provider Name | Alberto E Garcia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518047547 PECOS PAC ID: 1557331089 Enrollment ID: I20040730000342 |
| Provider Name | Vera C Garcia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154401107 PECOS PAC ID: 6204815160 Enrollment ID: I20040730000376 |
| Provider Name | Sara N Yarbrough |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437235199 PECOS PAC ID: 2466423314 Enrollment ID: I20040804000262 |
| Provider Name | Pamela H Temples |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740366442 PECOS PAC ID: 8527039445 Enrollment ID: I20040804000735 |
| Provider Name | Richard W.a. Rickman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609809300 PECOS PAC ID: 8921074667 Enrollment ID: I20040907000110 |
| Provider Name | Charles P Murrah |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1942253430 PECOS PAC ID: 5294635470 Enrollment ID: I20040916000375 |
| Provider Name | Thomas W Hobby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497749733 PECOS PAC ID: 5092763318 Enrollment ID: I20050104000332 |
| Provider Name | Alford T Brady |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467449272 PECOS PAC ID: 8628026960 Enrollment ID: I20050104000504 |
| Provider Name | Kathleen S Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1104819689 PECOS PAC ID: 1658322599 Enrollment ID: I20050208000579 |
| Provider Name | Dennis R Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821031329 PECOS PAC ID: 8729032685 Enrollment ID: I20050303000847 |
| Provider Name | Alan W Stout |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205878386 PECOS PAC ID: 3779511613 Enrollment ID: I20050801000987 |
| Provider Name | Daniel J Messcher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164455077 PECOS PAC ID: 4688603632 Enrollment ID: I20050810000137 |
| Provider Name | Prem Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124003587 PECOS PAC ID: 2961421730 Enrollment ID: I20051122000366 |
| Provider Name | William Nash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235172628 PECOS PAC ID: 6204729619 Enrollment ID: I20060720000227 |
| Provider Name | Shawn D Vandemark |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1336188176 PECOS PAC ID: 0244233989 Enrollment ID: I20060817000485 |
| Provider Name | Nicolas Psomiadis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720059637 PECOS PAC ID: 6800890278 Enrollment ID: I20060828000371 |
| Provider Name | Mahmood S Eisa |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184606824 PECOS PAC ID: 1456375161 Enrollment ID: I20061211000217 |
| Provider Name | Samuel Taylor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164436788 PECOS PAC ID: 1951303262 Enrollment ID: I20070215000050 |
| Provider Name | Jerthitia S Taylor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467468561 PECOS PAC ID: 8022010339 Enrollment ID: I20070215000066 |
| Provider Name | Hernando Moreno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396950994 PECOS PAC ID: 0840390944 Enrollment ID: I20070702000498 |
| Provider Name | Winston C Connell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144370206 PECOS PAC ID: 2668572793 Enrollment ID: I20070703000039 |
| Provider Name | Kamil I Hanna |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1881632099 PECOS PAC ID: 0749266831 Enrollment ID: I20070725000256 |
| Provider Name | Brian C Griner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366470650 PECOS PAC ID: 2163514175 Enrollment ID: I20070906000041 |
| Provider Name | Victoria L Meredith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538143987 PECOS PAC ID: 8022103712 Enrollment ID: I20070926000520 |
| Provider Name | Carlo Lee |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083619779 PECOS PAC ID: 1355424110 Enrollment ID: I20080218000025 |
| Provider Name | Phillip E Hadley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215098454 PECOS PAC ID: 4688750425 Enrollment ID: I20080319000558 |
| Provider Name | David W Retterbush |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1396910337 PECOS PAC ID: 1456430537 Enrollment ID: I20080430000496 |
| Provider Name | Francis Kwarteng |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1851551923 PECOS PAC ID: 1052470705 Enrollment ID: I20081110000521 |
| Provider Name | Paul Murray |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730183542 PECOS PAC ID: 1355400805 Enrollment ID: I20081112000684 |
| Provider Name | Cristi L Godwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407824832 PECOS PAC ID: 5890859052 Enrollment ID: I20090203000208 |
| Provider Name | Daren K Wooten |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811194483 PECOS PAC ID: 3375695273 Enrollment ID: I20090723000042 |
| Provider Name | Stephen T Zeigler |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649270554 PECOS PAC ID: 2466595467 Enrollment ID: I20100129000388 |
| Provider Name | Vanessa Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861503757 PECOS PAC ID: 4880729672 Enrollment ID: I20100318000464 |
| Provider Name | Joseph S Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437258506 PECOS PAC ID: 6608822218 Enrollment ID: I20100615000763 |
| Provider Name | Asa A Peek |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336127802 PECOS PAC ID: 1951432988 Enrollment ID: I20100708000265 |
| Provider Name | David Keith Parker |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306819040 PECOS PAC ID: 3779627369 Enrollment ID: I20100712000017 |
| Provider Name | William Harvey Miller |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326011057 PECOS PAC ID: 2961546551 Enrollment ID: I20100712000253 |
| Provider Name | Dallas M Miller |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184697815 PECOS PAC ID: 1052455649 Enrollment ID: I20100715000010 |
| Provider Name | Oscar Aguero |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962406918 PECOS PAC ID: 3678465424 Enrollment ID: I20100827000532 |
| Provider Name | Jonathan L Underwood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265612972 PECOS PAC ID: 6406040005 Enrollment ID: I20101027001264 |
| Provider Name | Kurt Martinuzzi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770504128 PECOS PAC ID: 3476653775 Enrollment ID: I20101129000716 |
| Provider Name | Annette S Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629129390 PECOS PAC ID: 5092902437 Enrollment ID: I20101210000061 |
| Provider Name | Ellen Eanes Courson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528080496 PECOS PAC ID: 8426245879 Enrollment ID: I20101210000250 |
| Provider Name | Jarod F Bailey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649432733 PECOS PAC ID: 4688842198 Enrollment ID: I20110727000221 |
| Provider Name | Pamela W Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184805400 PECOS PAC ID: 0143304741 Enrollment ID: I20110923000184 |
| Provider Name | Adam C Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346478542 PECOS PAC ID: 7012183940 Enrollment ID: I20111227000485 |
| Provider Name | Hernan Nunez Posas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689786055 PECOS PAC ID: 3971653221 Enrollment ID: I20120308000584 |
| Provider Name | Zakiyyah V Weatherspoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285904250 PECOS PAC ID: 0042470072 Enrollment ID: I20120328000456 |
| Provider Name | Hale E Hedley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669406260 PECOS PAC ID: 7810917176 Enrollment ID: I20120723000584 |
| Provider Name | Ruben Font |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194959916 PECOS PAC ID: 8123275302 Enrollment ID: I20120822000648 |
| Provider Name | Rita Drake Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346679537 PECOS PAC ID: 0345478814 Enrollment ID: I20140107000631 |
| Provider Name | Patrick Michael Parker |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1619170446 PECOS PAC ID: 4082869060 Enrollment ID: I20140317002153 |
| Provider Name | Elizabeth Flail |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548554124 PECOS PAC ID: 3870737000 Enrollment ID: I20140922001527 |
| Provider Name | Mesheal L Leverett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124420856 PECOS PAC ID: 6103149463 Enrollment ID: I20141218000820 |
| Provider Name | Kelly Blackmon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992110688 PECOS PAC ID: 3072830058 Enrollment ID: I20150401001028 |
| Provider Name | Dakshaben P Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467793000 PECOS PAC ID: 4183936107 Enrollment ID: I20150706001481 |
| Provider Name | David M Hardy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548467939 PECOS PAC ID: 7517105299 Enrollment ID: I20150902000673 |
| Provider Name | Bipin Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356453914 PECOS PAC ID: 1355341306 Enrollment ID: I20150909002780 |
| Provider Name | Rudolph Carlo King |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194797555 PECOS PAC ID: 4688820087 Enrollment ID: I20150929000388 |
| Provider Name | Mandy Lucas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346531662 PECOS PAC ID: 6800105198 Enrollment ID: I20151028001053 |
| Provider Name | Travis L Bailey |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1164711313 PECOS PAC ID: 9234449497 Enrollment ID: I20151030001637 |
| Provider Name | Anthony Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104186246 PECOS PAC ID: 4880850692 Enrollment ID: I20151102000983 |
| Provider Name | Windy Dawn Giddens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720451982 PECOS PAC ID: 1456651926 Enrollment ID: I20151207000177 |
| Provider Name | Olivia Hope Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255729513 PECOS PAC ID: 8325348733 Enrollment ID: I20151207002226 |
| Provider Name | Julia A Drake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487027967 PECOS PAC ID: 7113224049 Enrollment ID: I20160321001458 |
| Provider Name | Teki Susan Hegwood |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013001627 PECOS PAC ID: 2860456746 Enrollment ID: I20160330001138 |
| Provider Name | Ana Margarita Margarita Hernandez Silen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871752907 PECOS PAC ID: 2365635125 Enrollment ID: I20160803000543 |
| Provider Name | Jana D Harrod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477900355 PECOS PAC ID: 3779877121 Enrollment ID: I20160808000638 |
| Provider Name | Randal Jared Sanders |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1780983478 PECOS PAC ID: 4789832478 Enrollment ID: I20160809000228 |
| Provider Name | Stacy Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730621582 PECOS PAC ID: 4385926492 Enrollment ID: I20170125002936 |
| Provider Name | Michael Edward Kuo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760922264 PECOS PAC ID: 1658648258 Enrollment ID: I20170602001278 |
| Provider Name | Bernard J Wortman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386181238 PECOS PAC ID: 5092084145 Enrollment ID: I20170705000613 |
| Provider Name | Clifton Blayne Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659799757 PECOS PAC ID: 4688953037 Enrollment ID: I20170725002556 |
| Provider Name | Millie Taylor Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811440654 PECOS PAC ID: 0648541524 Enrollment ID: I20170810003531 |
| Provider Name | James Shoptaw Jr. |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1710951942 PECOS PAC ID: 3678543089 Enrollment ID: I20170822002228 |
| Provider Name | Kyle Moody Adams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508284431 PECOS PAC ID: 2466735915 Enrollment ID: I20170825002016 |
| Provider Name | Garrett Shane Surrency |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104348432 PECOS PAC ID: 7517239502 Enrollment ID: I20170825002328 |
| Provider Name | Taylor N Fiveash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962922427 PECOS PAC ID: 7618249558 Enrollment ID: I20170828001053 |
| Provider Name | Margaret C Carter-poore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235652421 PECOS PAC ID: 6507139136 Enrollment ID: I20170901002753 |
| Provider Name | Vicy Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417470162 PECOS PAC ID: 2567737083 Enrollment ID: I20171010002251 |
| Provider Name | Nathan Kelly Roberson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023532280 PECOS PAC ID: 6507122306 Enrollment ID: I20171110002426 |
| Provider Name | Lila L Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932620598 PECOS PAC ID: 5991061400 Enrollment ID: I20171115002335 |
| Provider Name | Jason A Swaby |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366735102 PECOS PAC ID: 7810112232 Enrollment ID: I20171218002088 |
| Provider Name | Eric Joseph Thomas |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1306107313 PECOS PAC ID: 0840505871 Enrollment ID: I20180119001806 |
| Provider Name | Laura Guadiana |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598084386 PECOS PAC ID: 5991920340 Enrollment ID: I20180125002138 |
| Provider Name | Michael E Anigbogu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417277625 PECOS PAC ID: 4082873161 Enrollment ID: I20180530000858 |
| Provider Name | James Richard Davis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033354741 PECOS PAC ID: 0244488930 Enrollment ID: I20180822001729 |
| Provider Name | Ashley Louise Exum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083122709 PECOS PAC ID: 4183974728 Enrollment ID: I20180901000148 |
| Provider Name | Timothy Blake Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356847743 PECOS PAC ID: 2769732288 Enrollment ID: I20180904003293 |
| Provider Name | Jessica Alferink |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235627464 PECOS PAC ID: 7416209358 Enrollment ID: I20181004001062 |
| Provider Name | Loan L Vu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1780909879 PECOS PAC ID: 3870769557 Enrollment ID: I20181004003060 |
| Provider Name | Brooke C Sukalski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467936179 PECOS PAC ID: 9436493996 Enrollment ID: I20181211000167 |
| Provider Name | Janice L Irvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760961155 PECOS PAC ID: 7719221126 Enrollment ID: I20181211002476 |
| Provider Name | Dilleta A Shackelford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811209208 PECOS PAC ID: 5294070736 Enrollment ID: I20190102002298 |
| Provider Name | Keegan A Michel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992169692 PECOS PAC ID: 3173804184 Enrollment ID: I20190211002664 |
| Provider Name | Teresa Tripp Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023580420 PECOS PAC ID: 7810235710 Enrollment ID: I20190220000432 |
| Provider Name | Megan L Miller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972965390 PECOS PAC ID: 9638465289 Enrollment ID: I20190318001570 |
| Provider Name | Jon R Teegardin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669955134 PECOS PAC ID: 1759622889 Enrollment ID: I20190417002833 |
| Provider Name | Thomas Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417474180 PECOS PAC ID: 6507109477 Enrollment ID: I20190515003452 |
| Provider Name | Xenophon Mucciarone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801216007 PECOS PAC ID: 9830319565 Enrollment ID: I20190528000466 |
| Provider Name | Robert G Kirtley |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1477780708 PECOS PAC ID: 1153654769 Enrollment ID: I20190613002957 |
| Provider Name | Apurav A Panwala |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1154684678 PECOS PAC ID: 7810207974 Enrollment ID: I20190807004159 |
| Provider Name | Davis Page Lester |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306208558 PECOS PAC ID: 4183917131 Enrollment ID: I20190819003634 |
| Provider Name | Brian R Pisula |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477999126 PECOS PAC ID: 3577789387 Enrollment ID: I20190822002932 |
| Provider Name | Eric B Edgerton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700248788 PECOS PAC ID: 6406142934 Enrollment ID: I20190823003550 |
| Provider Name | Michael D Caoile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184286684 PECOS PAC ID: 1153653829 Enrollment ID: I20191029003704 |
| Provider Name | Betsy E Tanner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295387751 PECOS PAC ID: 7113128141 Enrollment ID: I20191211003242 |
| Provider Name | Lucas Nathan Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770003592 PECOS PAC ID: 7214297944 Enrollment ID: I20191218002970 |
| Provider Name | Brian P Shields |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154596773 PECOS PAC ID: 4082882030 Enrollment ID: I20191223000880 |
| Provider Name | Corey W Dye |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679004097 PECOS PAC ID: 6103199435 Enrollment ID: I20200121000351 |
| Provider Name | Bhumiben Kushal Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467004507 PECOS PAC ID: 8628403680 Enrollment ID: I20200121002611 |
| Provider Name | Rachael N. Jefferson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447766738 PECOS PAC ID: 0840626545 Enrollment ID: I20200128001859 |
| Provider Name | James Phillip Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376517789 PECOS PAC ID: 2769810522 Enrollment ID: I20200310002503 |
| Provider Name | Lindsey Lawhorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992335855 PECOS PAC ID: 6204264641 Enrollment ID: I20200317002041 |
| Provider Name | Robin Brown Dillard |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871740324 PECOS PAC ID: 6709813330 Enrollment ID: I20200420000994 |
| Provider Name | Kimberly A Mackey |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1952533739 PECOS PAC ID: 5698055325 Enrollment ID: I20200501002888 |
| Provider Name | Danielle C Yund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700410602 PECOS PAC ID: 7315378528 Enrollment ID: I20200502000027 |
| Provider Name | Deborah S Lyon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528034832 PECOS PAC ID: 2062697584 Enrollment ID: I20200607000005 |
| Provider Name | Brad Jay Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639640436 PECOS PAC ID: 1850713199 Enrollment ID: I20200615003349 |
| Provider Name | Kristin Sharp Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306400601 PECOS PAC ID: 1557783552 Enrollment ID: I20200620000037 |
| Provider Name | Saikiran Raghavapuram |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1790065464 PECOS PAC ID: 1153648464 Enrollment ID: I20200713003560 |
| Provider Name | Jacqueline O'kane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396085981 PECOS PAC ID: 3870815970 Enrollment ID: I20200720001770 |
| Provider Name | Matthew Brown |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1275916827 PECOS PAC ID: 2567709710 Enrollment ID: I20200819003440 |
| Provider Name | Catherine Garfunkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275155517 PECOS PAC ID: 3678991320 Enrollment ID: I20200914000892 |
| Provider Name | Erin Nichole Satterfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164040556 PECOS PAC ID: 9133547789 Enrollment ID: I20200914001164 |
| Provider Name | Amit Bhavsar |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427131986 PECOS PAC ID: 7315379443 Enrollment ID: I20201027002120 |
| Provider Name | Kenneth James Burnsed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730796111 PECOS PAC ID: 9830165844 Enrollment ID: I20201029000948 |
| Provider Name | Daryoosh Derakhshan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1881936631 PECOS PAC ID: 5698068724 Enrollment ID: I20201102001487 |
| Provider Name | John William Ledwitch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528116019 PECOS PAC ID: 0941611560 Enrollment ID: I20201202002149 |
| Provider Name | Deepthi Gandhiraj |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1144621012 PECOS PAC ID: 6901183425 Enrollment ID: I20201204000157 |
| Provider Name | Tyler Tantisook |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326545823 PECOS PAC ID: 4385055805 Enrollment ID: I20201204000394 |
| Provider Name | Ruth H Duda |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063482230 PECOS PAC ID: 1456680842 Enrollment ID: I20201216002614 |
| Provider Name | Shelby Mcneal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265020358 PECOS PAC ID: 1254745409 Enrollment ID: I20210128002391 |
| Provider Name | Harold Howe |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1346500386 PECOS PAC ID: 4082879606 Enrollment ID: I20210217000918 |
| Provider Name | Geoffrey Yurcisin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821401233 PECOS PAC ID: 6608095757 Enrollment ID: I20210223003022 |
| Provider Name | Cole Seaton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205331170 PECOS PAC ID: 8820419831 Enrollment ID: I20210324000324 |
| Provider Name | Lauren Melissa Castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114512050 PECOS PAC ID: 8123435369 Enrollment ID: I20210406000249 |
| Provider Name | Heather Svenson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649381880 PECOS PAC ID: 3971911637 Enrollment ID: I20210416001872 |
| Provider Name | Lynda Dee Davis Ott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568522639 PECOS PAC ID: 6305246828 Enrollment ID: I20210621000923 |
| Provider Name | Robin M Stinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376108894 PECOS PAC ID: 3274866322 Enrollment ID: I20210803002453 |
| Provider Name | Vijay Bandhakavi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1184887473 PECOS PAC ID: 1951557859 Enrollment ID: I20210803003225 |
| Provider Name | Sarah Harrell Kester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255946414 PECOS PAC ID: 9335543982 Enrollment ID: I20210804002943 |
| Provider Name | Paige Huston Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477129104 PECOS PAC ID: 7416351317 Enrollment ID: I20210813000492 |
| Provider Name | William Hartley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003315227 PECOS PAC ID: 7315341229 Enrollment ID: I20210813000971 |
| Provider Name | Cheryl Lynn Chadwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952972259 PECOS PAC ID: 4981008802 Enrollment ID: I20210813001342 |
| Provider Name | Ryan Scott Brandt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356845788 PECOS PAC ID: 8527303007 Enrollment ID: I20210830001388 |
| Provider Name | Lucas Seibolt |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588074140 PECOS PAC ID: 6204100563 Enrollment ID: I20210914003144 |
| Provider Name | Rita Medina |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1922419928 PECOS PAC ID: 7911278627 Enrollment ID: I20210915000499 |
| Provider Name | Austin W Sorchik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598256331 PECOS PAC ID: 7810318839 Enrollment ID: I20210928001895 |
| Provider Name | Hannah Cheek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316573934 PECOS PAC ID: 6608264916 Enrollment ID: I20211019001158 |
| Provider Name | Tayler Robin Ebert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710658042 PECOS PAC ID: 4587052584 Enrollment ID: I20211025001529 |
| Provider Name | Vicki Wetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003445297 PECOS PAC ID: 1759770845 Enrollment ID: I20211111000017 |
| Provider Name | Laura Cardie Barbee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477068575 PECOS PAC ID: 9234493172 Enrollment ID: I20211124000248 |
| Provider Name | Grant P Barker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477013555 PECOS PAC ID: 4082956024 Enrollment ID: I20220221000669 |
| Provider Name | Julia H Goff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487309514 PECOS PAC ID: 0941697551 Enrollment ID: I20220429001119 |
| Provider Name | Stacey Newsome |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497390116 PECOS PAC ID: 3476940727 Enrollment ID: I20220505000244 |
| Provider Name | Jason Boyd Langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194471060 PECOS PAC ID: 2668859497 Enrollment ID: I20220517003288 |
| Provider Name | Edward Distler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1891180352 PECOS PAC ID: 8224381421 Enrollment ID: I20220707002997 |
| Provider Name | Howard Edward Bowers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538484167 PECOS PAC ID: 3173751856 Enrollment ID: I20220713001509 |
| Provider Name | Christopher Poore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871220525 PECOS PAC ID: 7315322112 Enrollment ID: I20220914003668 |
| Provider Name | Shalom Barile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649877200 PECOS PAC ID: 1254744352 Enrollment ID: I20221118001445 |
| Provider Name | Hunter L Clanton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447967575 PECOS PAC ID: 9032587266 Enrollment ID: I20221119000530 |
| Provider Name | Megan Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568198000 PECOS PAC ID: 8921479510 Enrollment ID: I20230118001525 |
| Provider Name | Douglas Holt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144337049 PECOS PAC ID: 4183782949 Enrollment ID: I20230124002305 |
| Provider Name | Richard Bias |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518595339 PECOS PAC ID: 0143645325 Enrollment ID: I20230125001505 |
| Provider Name | Diego Moreno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245761782 PECOS PAC ID: 1951724509 Enrollment ID: I20230201001329 |
| Provider Name | Andrew Mancusi-ungaro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346550415 PECOS PAC ID: 8426472002 Enrollment ID: I20230206001637 |
| Provider Name | Raymond A Hakh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962039933 PECOS PAC ID: 7012332323 Enrollment ID: I20230208000604 |
| Provider Name | Brendan Mcgowan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699301523 PECOS PAC ID: 5395162325 Enrollment ID: I20230209002047 |
| Provider Name | Ginger Ambron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881050375 PECOS PAC ID: 3779888383 Enrollment ID: I20230214000347 |
| Provider Name | Ashton Federico |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619504271 PECOS PAC ID: 3274956164 Enrollment ID: I20230214002108 |
| Provider Name | Kaitlin Hufstetler |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740784164 PECOS PAC ID: 0042563827 Enrollment ID: I20230302002242 |
| Provider Name | Samantha Noelle Baxley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629605381 PECOS PAC ID: 4688047020 Enrollment ID: I20230306000371 |
| Provider Name | Heather Streichert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669170643 PECOS PAC ID: 5991179970 Enrollment ID: I20230314001031 |
| Provider Name | Madison Hill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811474133 PECOS PAC ID: 0143629311 Enrollment ID: I20230323000981 |
| Provider Name | Austin Meng |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043848542 PECOS PAC ID: 0042638298 Enrollment ID: I20230406000910 |
| Provider Name | Joy Turner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568093052 PECOS PAC ID: 0345664645 Enrollment ID: I20230508001749 |
| Provider Name | Jayme Erin Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912528084 PECOS PAC ID: 3779941471 Enrollment ID: I20230627002371 |
| Provider Name | Amrendra K Mandal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1518480250 PECOS PAC ID: 1254675358 Enrollment ID: I20230705000203 |
| Provider Name | Jeff Anucha |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942652524 PECOS PAC ID: 3072973270 Enrollment ID: I20230719004304 |
| Provider Name | Brittany Michelle Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780357152 PECOS PAC ID: 8325408263 Enrollment ID: I20230724002635 |
| Provider Name | Leah R Goodson-gerami |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861782450 PECOS PAC ID: 5991003394 Enrollment ID: I20230808000411 |
| Provider Name | Ene Grace Morgan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821651951 PECOS PAC ID: 9830551779 Enrollment ID: I20230809003335 |
| Provider Name | Davis Wood |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124654157 PECOS PAC ID: 2466814157 Enrollment ID: I20230811001729 |
| Provider Name | Gary-wayne Luke Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164205183 PECOS PAC ID: 1254794142 Enrollment ID: I20230824003053 |
| Provider Name | Reanne Catherine Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841829272 PECOS PAC ID: 0648633180 Enrollment ID: I20230830003583 |
| Provider Name | Katelin Cristine Mcleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407539620 PECOS PAC ID: 8022464114 Enrollment ID: I20231025003142 |
| Provider Name | Leigh Hendley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437795572 PECOS PAC ID: 7911390133 Enrollment ID: I20231219003738 |
| Provider Name | Carter Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497535637 PECOS PAC ID: 8628411840 Enrollment ID: I20240205002893 |
| Provider Name | Amy Roberson Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851929962 PECOS PAC ID: 1557708104 Enrollment ID: I20240319002442 |
| Provider Name | Vivek Yadav |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1003331638 PECOS PAC ID: 2365882818 Enrollment ID: I20240430004225 |
| Provider Name | William Thomas Mulligan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023868999 PECOS PAC ID: 8527408699 Enrollment ID: I20240507000497 |
Joseph S Thomas M D Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Connell Rd, Ste T, Valdosta, GA 31602 Phone: 229-242-9565 Fax: 229-242-1725 | |
Care Medical Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2804 N Oak St, Suite C, Valdosta, GA 31602 Phone: 229-241-8925 Fax: 229-241-7672 | |
Griner Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3301 N Oak Street Ext, Valdosta, GA 31605 Phone: 229-242-6061 Fax: 229-242-6151 | |
Valdosta Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3300 Greystone Way, Valdosta, GA 31605 Phone: 229-247-7700 | |
Valdosta Gastroenterology Associates, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 410 Connell Rd, Valdosta, GA 31602 Phone: 229-244-1570 Fax: 229-247-1084 | |
Partnership Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Griffin Ave, Valdosta, GA 31601 Phone: 229-245-0020 Fax: 229-245-9855 | |
Bennett P Hogan Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 117 W Northside Dr, Valdosta, GA 31602 Phone: 229-333-0616 Fax: 229-333-0647 |