NPIMap

Organization Active NPI

Richard D. Gonzales, M.D., P.C.

  • Family Medicine Physician
  • Jasper, GA
National Provider Identifier
1295880565
Registry record updated Dec 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
044925 Issued in GA
Legal business name
RICHARD D. GONZALES, M.D., P.C.
Practice address
735 Martin Rd
Suite a
Jasper, GA 30143-8411
Phone
(706) 253-3366
Fax
(706) 253-2243
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2007

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

Authorized official

Name
Richard D Gonzales, M.D.NPI 1386795474
Title
President
Phone
(706) 253-3366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 044925 GA Primary

Addresses

Primary practice location

735 Martin Rd
Suite a
Jasper, GA 30143-8411

Mailing address

735 Martin Rd
Suite a
Jasper, GA 30143-8411
Phone (706) 253-3366

Other identifiers 1

IdentifierTypeStateIssuer
00804251BMedicaidGA

Other names 1

  • Archway Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

735 Martin Rd
Unit A
Jasper, GA 30143
Phone (706) 253-3366

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1295880565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 MARTIN RD",
            "address_2": "SUITE A",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301438411",
            "telephone_number": "706-253-3366",
            "fax_number": "706-253-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 MARTIN RD",
            "address_2": "SUITE A",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301438411",
            "telephone_number": "706-253-3366",
            "fax_number": "706-253-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD D. GONZALES, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-253-3366",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "044925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00804251B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Archway Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jasper, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.

Verify at the official NPI Registry.