Individual provider Active NPI

Quinnon Ralph Purvis, M.D.

  • Family Medicine Physician
  • Fort Gordon, GA
National Provider Identifier
1710046990
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11308 Issued in FL
Practice address
300 W Hospital Road
Eisenhower Army Medical Center Attn Credentials
Fort Gordon, GA 30905-5650
Phone
(706) 787-2720
Fax
(706) 787-8176
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11308 FL Primary

Addresses

Primary practice location

300 W Hospital Road
Eisenhower Army Medical Center Attn Credentials
Fort Gordon, GA 30905-5650

Mailing address

300 W Hospital Road
Attn Credentials
Ft Gordon, GA 30905-5650
Phone (706) 787-2720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151102002572 GA Order and Referring Only - Family PracticePractitioner - Family Practice 7416267554

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11308FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richard R. Wilson, D.O. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710046990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL ROAD",
            "address_2": "ATTN CREDENTIALS",
            "city": "FT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-2720",
            "fax_number": "706-787-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL ROAD",
            "address_2": "EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-2720",
            "fax_number": "706-787-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURVIS",
        "first_name": "QUINNON",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "11308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gordon, GA

Sources for this page

Verify at the official NPI Registry.