Active NPI
Bertram Vinson, RN
- Registered Nurse
- Tifton, GA
National Provider Identifier
1780974741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 135412
- Practice address
- 334 Tifton Eldorado Rd
Tifton, GA 31794-9497 - Phone
- (229) 391-2300
- Fax
- (229) 386-3221
- NPI assigned
- Apr 12, 2011
- Last updated
- Apr 12, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 135412 | GA | Primary |
Addresses
Primary practice location
334 Tifton Eldorado Rd
Tifton, GA 31794-9497
Mailing address
3120 N Oak Street Ext Ste C
Valdosta, GA 31602-5910
Phone (229) 671-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135412 | Other | GA | LICENSE NUMBER |
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 135412 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302566400000",
"number": "1780974741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 N OAK STREET EXT STE C",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316025910",
"telephone_number": "229-671-6100",
"fax_number": "229-671-6774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "334 TIFTON ELDORADO RD",
"city": "TIFTON",
"state": "GA",
"postal_code": "317949497",
"telephone_number": "229-391-2300",
"fax_number": "229-386-3221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINSON",
"first_name": "BERTRAM",
"name_prefix": "Mr.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-12",
"last_updated": "2011-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "135412",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "135412",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tifton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.