NPIMap

Organization Active NPI

Robert D. Mixson MD PA a Georgia Corp

  • Obstetrics & Gynecology Physician
  • Saint Marys, GA
National Provider Identifier
1326209859
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
39415 Issued in GA
Legal business name
ROBERT D. MIXSON MD PA A GEORGIA CORP
Practice address
104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803
Phone
(912) 882-7100
Fax
(912) 882-9149
NPI assigned
Jun 18, 2008
Last updated
Dec 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Authorized official

Name
Dr. Robert David Mixson, M.D.NPI 1912904459
Title
Owner
Phone
(912) 882-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 39415 GA Primary

Addresses

Primary practice location

104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803

Mailing address

104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803
Phone (912) 882-7100

Other identifiers 1

IdentifierTypeStateIssuer
000643431AMedicaidGA

National Provider Directory

National Provider Directory

Locations

104 Lakeshore Dr
Ste A
Saint Marys, GA 31558
Phone (912) 882-7100

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1326209859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LAKESHORE DR",
            "address_2": "STE A",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583803",
            "telephone_number": "912-882-7100",
            "fax_number": "912-882-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LAKESHORE DR",
            "address_2": "STE A",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583803",
            "telephone_number": "912-882-7100",
            "fax_number": "912-882-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT D. MIXSON MD PA A GEORGIA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "MIXSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-882-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "39415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000643431A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Marys, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.