NPIMap

Individual provider Active NPI

Tonya Fowler Fordham, D.O.

  • Family Medicine Physician
  • Baxley, GA
National Provider Identifier
1861462053
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
049292 Issued in GA
Practice address
18 Luckie St
Ste F
Baxley, GA 31513-0358
Phone
(912) 366-1362
Fax
(912) 366-1365
NPI assigned
Jan 23, 2006
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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 049292 GA Primary

Addresses

Primary practice location

18 Luckie St
Ste F
Baxley, GA 31513-0358

Mailing address

18 Luckie St
Ste F
Baxley, GA 31513-0358
Phone (912) 366-1362

Other identifiers 2

IdentifierTypeStateIssuer
100442OtherBCBS
00947273AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060419000257 GA Practitioner - Family PracticePractitioner - Emergency Medicine 9335158369 Reassigns benefits to 4 organizations
Receives reassigned benefits from 2 practitioners
Practice locations: Baxley, GA

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Emergency Medical Services Consolidated, LLCGroup PAC ID 4183871320, 48 clinicians
Southland Consolidated Emergency Services LLCGroup PAC ID 2860792066, 68 clinicians

Practice addresses (Care Compare)

145 E Peacock St
Cochran, GA 31014-7846
Phone (229) 200-4950

163 E Tollison St
Baxley, GA 31513-0120
Phone (912) 367-9841

277 Lackawanna St
Baxley, GA 31513-8072
Phone (912) 366-1362

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Baxley and Appling County Hospital Authority CurrentSince Oct 31, 2016 Accepting new patients
South Georgia ER Services, LLC CurrentSince Jun 1, 2023 Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients
Gordonia Emergency Physicians Past Accepting new patients
Doctors of Compassionate Services Family Medicine PastSince Jan 1, 1990 Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients

Locations

163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847

654 S Main St
Baxley, GA 31513
Phone (912) 366-6029

340 Eisenhower Dr
Ste 1305
Savannah, GA 31406
Phone (706) 975-5993

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11298/brand/1/csg/1/fhir/r4
  • Direct secure messaging: tonya.fordham.1@11298.direct.athenahealth.com

Practitioners & affiliated clinicians

Practitioners 2

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.

Organizations & group practices 10

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1861462053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 LUCKIE ST",
            "address_2": "STE F",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130358",
            "telephone_number": "912-366-1362",
            "fax_number": "912-366-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 LUCKIE ST",
            "address_2": "STE F",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130358",
            "telephone_number": "912-366-1362",
            "fax_number": "912-366-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDHAM",
        "first_name": "TONYA",
        "middle_name": "FOWLER",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "049292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "100442",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00947273A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.