Misty D. Poole, MD, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MISTY D. POOLE, MD, LLC

Practice address

210 Mose Coleman Dr
Vidalia, GA 30474-8677

Phone

(912) 537-2200

Fax

(912) 537-2260

NPI assigned

May 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Misty D Poole, MDNPI 1134358419

Title

Owner

Phone

(912) 537-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vidalia Internal Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Misty Denise Poole, M.D.

  • Internal Medicine Physician
  • Vidalia, GA
  • NPI 1134358419
  Medicare reassignment Care Compare group NPD Authorized official
• Elisabeth Ann Proenza, FNP-C

  • Family Nurse Practitioner
  • Vidalia, GA
  • NPI 1619591120
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1003176546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 MOSE COLEMAN DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748677",
            "telephone_number": "912-537-2200",
            "fax_number": "912-537-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MOSE COLEMAN DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748677",
            "telephone_number": "912-537-2200",
            "fax_number": "912-537-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTY D. POOLE, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-537-2200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2021111317",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vidalia Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marla Kristen Mikell, FNP-C
• Janice Miller
• Lauren Courtney Miller, M.D.
• Shannon Davy Mimbs, MACMHC, MDIV
• Mary Minter, NP-C
• Dianne S Mixon, PA-C
• Christine Mobley
• Molly M. Kramer M.D.,P.C.
• Susan J Montford, ARNP, FNP-C
• Montgomery Emergency Group, LLC

• Internal Medicine Physician in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.