Active NPI
Johnny R Wilborn, MD
- Internal Medicine Physician
- Gadsden, AL
National Provider Identifier
1558441444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 9133
- Practice address
- 100 Medical Center Dr
#207
Gadsden, AL 35903-1134 - Phone
- (256) 492-4001
- Fax
- (256) 492-4031
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 9133 | AL | Primary |
Addresses
Primary practice location
100 Medical Center Dr
#207
Gadsden, AL 35903-1134
Mailing address
100 Medical Center Dr
#207
Gadsden, AL 35903-1134
Phone (256) 492-4001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-95241 | Other | AL | AL BCBS |
| 1558441444 / 109107 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9133 | AL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245715200000",
"number": "1558441444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MEDICAL CENTER DR",
"address_2": "#207",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359031134",
"telephone_number": "256-492-4001",
"fax_number": "256-492-4031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MEDICAL CENTER DR",
"address_2": "#207",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359031134",
"telephone_number": "256-492-4001",
"fax_number": "256-492-4031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBORN",
"first_name": "JOHNNY",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2009-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "9133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AL BCBS",
"identifier": "515-95241",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1558441444 / 109107",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gadsden, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.