NPIMap

Organization Active NPI

Gordonia Emergency Physicians

  • Emergency Medicine Physician
  • Reidsville, GA
National Provider Identifier
1497953822
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
GORDONIA EMERGENCY PHYSICIANS
Practice address
247 S Main St
Reidsville, GA 30453-4605
Phone
(912) 557-1000
NPI assigned
Jul 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jennifer Provasnik
Title
Supervisor of Provider Enrollment
Phone
(800) 355-0808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

247 S Main St
Reidsville, GA 30453-4605

Mailing address

PO Box 41631
Philadelphia, PA 19101-1631
Phone (800) 355-0808

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497953822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41631",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191011631",
            "telephone_number": "800-355-0808",
            "fax_number": "215-834-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 S MAIN ST",
            "city": "REIDSVILLE",
            "state": "GA",
            "postal_code": "304534605",
            "telephone_number": "912-557-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDONIA EMERGENCY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROVASNIK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "SUPERVISOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "800-355-0808"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, GA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.