Antonio R Sison, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

053172 Issued in GA

Practice address

119 Norman Dorminy Dr Ste C
Fitzgerald, GA 31750-8855

Phone

(229) 423-5843

Fax

(229) 423-9847

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

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.

• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1922080100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 NORMAN DORMINY DR STE C",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508855",
            "telephone_number": "229-423-5843",
            "fax_number": "229-423-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 NORMAN DORMINY DR STE C",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508855",
            "telephone_number": "229-423-5843",
            "fax_number": "229-423-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISON",
        "first_name": "ANTONIO",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "053172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284021398B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "02BDJLF",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita M Ross, FNP
• Rural Urgent Care LLC
• Danny Sapp
• Tonya Michelle Schell
• James Benjamin Shiflett Jr., DPT
• Smile Mission Fitzgerald LLC
• Anna Nicole Smith
• John Smith
• Judith Elaine Smith, M.DIV
• Lynne D Smith, F.N.P.-C

• Surgery Physician in Fitzgerald, GA
• Providers in Fitzgerald, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; 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.