NPIMap

Organization Active NPI

Meadows Multispecialty Associates, LLC

  • Internal Medicine Physician
  • Lyons, GA
National Provider Identifier
1952990533
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEADOWS MULTISPECIALTY ASSOCIATES, LLC
Practice address
110 RT Stanley Sr PL
Lyons, GA 30436-5623
Phone
(912) 526-9355
NPI assigned
Jan 18, 2021
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
William Tedrick Johnson
Title
Ao/Group Vice President
Phone
(615) 372-3375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

110 RT Stanley Sr PL
Lyons, GA 30436-5623

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 376-7600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210407000556 GA Part B Supplier - Clinic/Group Practice 6002223484 Receives reassigned benefits from 34 practitioners
Practice locations: Lyons, GA; Vidalia, GA; Hazlehurst, GA; Dublin, GA; Baxley, GA

National Provider Directory

National Provider Directory

Locations

105 E Tollison St
Ste C
Baxley, GA 31513
Phone (912) 367-4122

1707 Meadows Ln
Ste F
Vidalia, GA 30474
Phone (912) 386-1212

504 Maple Dr
#B
Vidalia, GA 30474
Phone (912) 216-6161

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1952990533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-376-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 RT STANLEY SR PL",
            "city": "LYONS",
            "state": "GA",
            "postal_code": "304365623",
            "telephone_number": "912-526-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOWS MULTISPECIALTY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-18",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDRICK",
        "authorized_official_title_or_position": "AO/GROUP VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyons, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.