NPIMap

Organization Active NPI

Madison Primary Care, LLC

  • Family Medicine Physician
  • Madison, GA
National Provider Identifier
1710911458
Registry record updated Aug 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
015584 Issued in GA
Legal business name
MADISON PRIMARY CARE, LLC
Practice address
1820 Bethany Rd
Madison, GA 30650-4701
Phone
(706) 342-3103
Fax
(706) 342-7430
NPI assigned
Jul 10, 2006
Last updated
Aug 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2007

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

Authorized official

Name
Timothy B Gibson, MD
Title
Ceo
Phone
(706) 342-3103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 015584 GA Primary

Addresses

Primary practice location

1820 Bethany Rd
Madison, GA 30650-4701

Mailing address

1820 Bethany Rd
Madison, GA 30650-4701
Phone (706) 342-3103

National Provider Directory

National Provider Directory

Locations

1311 Atlanta Hwy
Ste C
Madison, GA 30650
Phone (706) 342-3103

Practitioners & affiliated clinicians

Practitioners 6

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": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1710911458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 BETHANY RD",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306504701",
            "telephone_number": "706-342-3103",
            "fax_number": "706-342-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 BETHANY RD",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306504701",
            "telephone_number": "706-342-3103",
            "fax_number": "706-342-7430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-342-3103",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "015584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; 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.