Integrated Telehealth LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INTEGRATED TELEHEALTH LLC

Practice address

1523 Old Valdosta Rd Ste B
Ray City, GA 31645

Phone

(877) 543-7221

Fax

(877) 755-2212

NPI assigned

Jul 31, 2017

Organization subpart

Yes

Parent organization

INTEGRATED TELEHEALTH LLCAs reported in NPPES

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

Authorized official

Name

Dr. Jon C Gibbs, MD

Title

Director

Phone

(706) 831-0204

Specialties & licenses 2

Addresses

Other identifiers 2

Part of

Integrated Telehealth LLC

Locations

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1699299842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 OLD VALDOSTA RD STE B",
            "city": "RAY CITY",
            "state": "GA",
            "postal_code": "316457132",
            "telephone_number": "877-543-7221",
            "fax_number": "877-755-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 OLD VALDOSTA RD STE B",
            "city": "RAY CITY",
            "state": "GA",
            "postal_code": "31645",
            "telephone_number": "877-543-7221",
            "fax_number": "877-755-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "342 Tifton Worth County Line Rd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317935125",
            "country_code": "US",
            "telephone_number": "478-449-1255",
            "fax_number": "404-481-2078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED TELEHEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATED TELEHEALTH LLC",
        "enumeration_date": "2017-07-31",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "706-831-0204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G38493",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000616624F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Ray City, GA
• Providers in Ray City, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; 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.