Active NPI
Brad T Mathias
- Otolaryngology Physician
- Milledgeville, GA
National Provider Identifier
1649450586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 46786
- Practice address
- 850 W Thomas St
Milledgeville, GA 31061-2674 - Phone
- (478) 452-4800
- NPI assigned
- Nov 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 46786 | GA | Primary |
Addresses
Primary practice location
850 W Thomas St
Milledgeville, GA 31061-2674
Mailing address
850 W Thomas St
Milledgeville, GA 31061-2674
Phone (478) 452-4800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00813799A | Medicaid | GA |
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 |
|---|---|---|---|
| 46786 | GA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1649450586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 W THOMAS ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310612674",
"telephone_number": "478-452-4800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 W THOMAS ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310612674",
"telephone_number": "478-452-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIAS",
"first_name": "BRAD",
"middle_name": "T",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-08",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "GA",
"license": "46786",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00813799A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.