NPIMap

Organization Active NPI

Vidalia Urology Associates, LLC

  • Urology Physician
  • Swainsboro, GA
National Provider Identifier
1053556118
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
026533 Issued in GA
Legal business name
VIDALIA UROLOGY ASSOCIATES, LLC
Practice address
120A Victory Dr
Swainsboro, GA 30401-3235
Phone
(912) 537-9481
Fax
(912) 537-1380
NPI assigned
Dec 3, 2008
Last updated
Dec 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

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

Authorized official

Name
Gilbert GonzalezNPI 1316930464
Title
MD
Phone
(912) 537-9481

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 026533 GA Primary

Addresses

Primary practice location

120A Victory Dr
Swainsboro, GA 30401-3235

Mailing address

303 Harris Industrial Blvd
Suite 5
Vidalia, GA 30474-8853
Phone (912) 537-9481

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1053556118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 HARRIS INDUSTRIAL BLVD",
            "address_2": "SUITE 5",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748853",
            "telephone_number": "912-537-9481",
            "fax_number": "912-537-1380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120A VICTORY DR",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013235",
            "telephone_number": "912-537-9481",
            "fax_number": "912-537-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALIA UROLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "912-537-9481"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "026533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swainsboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.