Active NPI
John W Patrick, M.D.
- Diagnostic Radiology Physician
- Thomaston, GA
National Provider Identifier
1124023023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 011438
- Practice address
- 801 W Gordon St
Thomaston, GA 30286-3426 - Phone
- (706) 647-8111
- Fax
- (706) 647-4389
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 011438 | GA | Primary |
Addresses
Primary practice location
801 W Gordon St
Thomaston, GA 30286-3426
Mailing address
PO Box 589
Thomaston, GA 30286-0008
Phone (706) 647-8111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 520322900001 | Other | GA | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011438 | GA | MD | Diagnostic Radiology Physician |
| 11438 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124023023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 589",
"city": "THOMASTON",
"state": "GA",
"postal_code": "302860008",
"telephone_number": "706-647-8111",
"fax_number": "706-647-4389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 W GORDON ST",
"city": "THOMASTON",
"state": "GA",
"postal_code": "302863426",
"telephone_number": "706-647-8111",
"fax_number": "706-647-4389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATRICK",
"first_name": "JOHN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "GA",
"license": "011438",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "520322900001",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thomaston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.