NPIMap

Organization Active NPI

Crisp General Internal Medicine Inc

  • Medical Specialty Clinic/Center
  • Cordele, GA
National Provider Identifier
1669632014
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
060593 Issued in GA
Legal business name
CRISP GENERAL INTERNAL MEDICINE INC
Practice address
416 E 4TH Ave Ste B
Cordele, GA 31015-3729
Phone
(229) 273-8501
Fax
(229) 273-2515
NPI assigned
Jun 10, 2008
Last updated
Jun 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

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

Authorized official

Name
Dr. Kevin Holloway, M.D.
Title
President
Phone
(229) 273-4989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 060593 GA Primary

Addresses

Primary practice location

416 E 4TH Ave Ste B
Cordele, GA 31015-3729

Mailing address

1801 Quail Run
Cordele, GA 31015-2096
Phone (229) 273-4989

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1669632014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 QUAIL RUN",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310152096",
            "telephone_number": "229-273-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E 4TH AVE STE B",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153729",
            "telephone_number": "229-273-8501",
            "fax_number": "229-273-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISP GENERAL INTERNAL MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-273-4989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "060593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordele, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.