Active NPI
William W Brazil, PA
- Physician Assistant
- Thomasville, GA
National Provider Identifier
1184696759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- GA001990
- Practice address
- 100 Mimosa Dr
Thomasville, GA 31792-6676 - Phone
- (229) 226-9141
- Fax
- (229) 228-0637
- NPI assigned
- Feb 7, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | GA001990 | GA | Primary |
Addresses
Primary practice location
100 Mimosa Dr
Thomasville, GA 31792-6676
Mailing address
100 Mimosa Dr
Ste 1R
Thomasville, GA 31792-6678
Phone (229) 227-1690
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302656 | Other | GA | WELLCARE |
| 100001302A | Medicaid | GA | |
| 100001302A | Other | GA | PEACH STATE |
| 970009975 | Other | GA | RAIL ROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001990 | GA | MD | Clinical Social Worker |
| GA001990 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555891200000",
"number": "1184696759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MIMOSA DR",
"address_2": "STE 1R",
"city": "THOMASVILLE",
"state": "GA",
"postal_code": "317926678",
"telephone_number": "229-227-1690",
"fax_number": "229-227-1829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MIMOSA DR",
"city": "THOMASVILLE",
"state": "GA",
"postal_code": "317926676",
"telephone_number": "229-226-9141",
"fax_number": "229-228-0637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZIL",
"first_name": "WILLIAM",
"middle_name": "W",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2019-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "GA001990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "302656",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100001302A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACH STATE",
"identifier": "100001302A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "970009975",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thomasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.