Active NPI
Philip Shadle
- Durable Medical Equipment & Medical Supplies
- Dawsonville, GA
National Provider Identifier
1861858730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Practice address
- 413 Spring Ridge Dr
Dawsonville, GA 30534-6145 - Phone
- (678) 751-5340
- NPI assigned
- Jan 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
413 Spring Ridge Dr
Dawsonville, GA 30534-6145
Mailing address
413 Spring Ridge Dr
Dawsonville, GA 30534-6145
Phone (678) 751-5340
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452211200000",
"number": "1861858730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 SPRING RIDGE DR",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305346145",
"telephone_number": "678-751-5340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 SPRING RIDGE DR",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305346145",
"telephone_number": "678-751-5340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADLE",
"first_name": "PHILIP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-01-08",
"last_updated": "2016-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dawsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.