Stacey W Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

041324 Issued in GA

Practice address

509 Gordon Ave
Thomasville, GA 31792

Phone

(229) 226-7544

Fax

(229) 226-0314

NPI assigned

Mar 10, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)
• John D Archbold Memorial Hospital Inc

  dba Archbold Memorial

  • General Acute Care Hospital
  • Thomasville, GA
  • NPI 1194779702
  NPD (past)
• The Pediatric Center LLC

  • Primary Care Clinic/Center
  • Cairo, GA
  • NPI 1104047075
  NPD (past)
• The Pediatric Center LLC

  • Primary Care Clinic/Center
  • Thomasville, GA
  • NPI 1760602783
  NPD (past)

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376511667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2258",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "31799",
            "telephone_number": "229-226-7544",
            "fax_number": "229-226-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "31792",
            "telephone_number": "229-226-7544",
            "fax_number": "229-226-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACEY",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "041324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000706439B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000706439C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaila Nicole Johnson, PHARMD
• Marlin S Johnson, D.M.D.
• Michael Johnson, PT, DPT
• Quinetta L Johnson, MS
• Sarah Ardanuy Johnson, L.D.
• Jones Behavioral Health LLC
• Katrina Rena Jones
• Latarsha Jones, ARNP
• Lovetta Jones
• Sandra Bryant Jones, PHARM.D., CPH

• Pediatrics Physician in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.

Verify at the official NPI Registry.