Individual provider Active NPI

Michael Vidal, MD

  • Internal Medicine Physician
  • Gainesville, GA
National Provider Identifier
1962106740
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
111782 Issued in GA
Practice address
1439 Jesse Jewell Pkwy NE Ste 301
Gainesville, GA 30501-3806
Phone
(770) 219-0023
NPI assigned
Mar 28, 2023
Last updated
Jun 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 111782 GA Primary

Addresses

Primary practice location

1439 Jesse Jewell Pkwy NE Ste 301
Gainesville, GA 30501-3806

Mailing address

743 Spring St NE Ste 710
Gainesville, GA 30501-3715
Phone (770) 219-8730

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230712004784 GA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3971963679

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111782GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Physicians Group Inc Internal Medicine CurrentSince Apr 6, 2023 Accepting new patients

Locations

1439 Jesse Jewell Pkwy NE
Ste 301
Gainesville, GA 30501
Phone (770) 219-0023

743 Spring St NE
Ste 710
Gainesville, GA 30501
Phone (770) 219-1200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1962106740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE STE 710",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013715",
            "telephone_number": "770-219-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 JESSE JEWELL PKWY NE STE 301",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013806",
            "telephone_number": "770-219-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-28",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "111782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.