Individual provider Active NPI

John Philip Douglas, MD

  • Student in an Organized Health Care Education/Training Program
  • Columbus, GA
National Provider Identifier
1093447153
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2122 Manchester Expy
Columbus, GA 31904-6878
Phone
(706) 596-4456
Fax
(706) 596-4457
NPI assigned
Jun 28, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2122 Manchester Expy
Columbus, GA 31904-6878

Mailing address

2122 Manchester Expy
Columbus, GA 31904-6878
Phone (706) 596-4456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251009004116 TN Practitioner - Internal Medicine 6901303312

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3303 NW Expressway
Suite 1000
Oklahoma City, OK 73112-5468

PO Box
Suite 207829
Dallas, TX 75320-7829

Hospital & facility affiliations

  • Parkwest Medical Center Hospital, Knoxville, TN, CCN 440173

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Statcare Inpatient LLC CurrentSince Oct 1, 2025 Accepting new patients

Locations

1901 Clinch Ave
Knoxville, TN 37916
Phone (865) 331-1111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1093447153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 MANCHESTER EXPY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319046878",
            "telephone_number": "706-596-4456",
            "fax_number": "706-596-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 MANCHESTER EXPY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319046878",
            "telephone_number": "706-596-4456",
            "fax_number": "706-596-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JOHN",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.