East Georgia Internal Medicine ,LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EAST GEORGIA INTERNAL MEDICINE ,LLC

Practice address

811 13TH St
Suite 11
Augusta, GA 30901-2700

Phone

(706) 736-4154

Fax

(706) 736-4155

NPI assigned

Aug 30, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Oladapo O Fawibe, M.D.NPI 1225031651

Title

Director

Phone

(706) 736-4154

Specialties & licenses 1

Addresses

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

Locations

Practitioners 5

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.

• Oladapo O Fawibe I, MD

  • Internal Medicine Physician
  • Augusta, GA
  • NPI 1225031651
  Medicare reassignment NPD Authorized official
• Abiy Dessalegn Mekoya, MD

  • Internal Medicine Physician
  • Augusta, GA
  • NPI 1023064938
  Medicare reassignment NPD
• Brandis Bannister, FNP

  • Family Nurse Practitioner
  • Augusta, GA
  • NPI 1275943581
  NPD (past)
• Ashley Janae Thomas, PA-C

  • Medical Physician Assistant
  • Augusta, GA
  • NPI 1740515063
  NPD (past)
• Dana Denise Wicker, NP

  • Nurse Practitioner
  • Augusta, GA
  • NPI 1407484751
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194835280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309143407",
            "telephone_number": "706-736-4154",
            "fax_number": "706-736-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 13TH ST",
            "address_2": "SUITE 11",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012700",
            "telephone_number": "706-736-4154",
            "fax_number": "706-736-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA INTERNAL MEDICINE ,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAWIBE",
        "authorized_official_first_name": "OLADAPO",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "706-736-4154",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Central Health District
• East Central Health District (Richmond County Health Department)
• East Central Health District
• East Central Health District (Richmond County Health Department)
• East Central Public Health District
• Kenneth Scott Easters, DO
• Blake Eaton, DDS
• Joanne Eaves
• Kanisha Nicole Eberhardt, QASP-S
• Chelsea R Eberhart

• Internal Medicine Physician in Augusta, GA
• Providers in Augusta, 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 Aug 22, 2020; 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.