Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207Q00000X | Family Medicine | | 051662 | GEORGIA | No |
| 2 | 207P00000X | Emergency Medicine | | 051662 | GEORGIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | P00394402 | OTHER | GEORGIA | RR MEDICARE ID FOR URGENTONE |
| 2 | 000955248J | OTHER | GEORGIA | GA MEDICAID ID FOR URGENTONE IN SAVANNAH |
| 3 | 52002512-008 | OTHER | GEORGIA | BCBS/GA ID FOR URGENTONE IN SAVANNAH |
| 4 | G46909 | OTHER | SOUTH CAROLINA | SC MEDICAID ID FOR URGENTONE |
| 5 | GPA892 | OTHER | SOUTH CAROLINA | SC MEDICAID GROUP ID FOR URGENTONE IN POOLER |
| 6 | GPA902 | OTHER | SOUTH CAROLINA | SC MEDICAID GROUP ID FOR URGENTONE IN |
| 7 | GRP2837 | OTHER | GEORGIA | GA MEDICARE GROUP ID FOR URGENTONE |
| 8 | CG4057 | OTHER | GEORGIA | RR MEDICARE GROUP ID FOR URGENTONE |
| 9 | H63842 | MEDICARE UPIN | GEORGIA | |
| 10 | 000955248K | OTHER | GEORGIA | GA MEDICAID ID FOR URGENTONE IN POOLER |
| 11 | 52002512-009 | OTHER | GEORGIA | BCBS/GA ID FOR URGENTONE IN POOLER |
| 12 | 202I088189 | OTHER | GEORGIA | GA MEDICARE ID FOR URGENTONE |
