GENTRY BROACH TOLBERT (NPI# 1144517038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144517038 |
| Entity Type | Individual |
| Full Name | GENTRY BROACH TOLBERT |
| Credential | N.P. |
| Practice Address |
1500 Langford Medical Drive Bldg 200 Bogart GA 30622 |
| Practice Telephone | 7062080451 |
| Mailing Telephone | 7062080451 |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2012-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN175489 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1500 LANGFORD MEDICAL DRIVE BLDG 200 |
| City | BOGART |
| State | GA |
| Zip Code | 30622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841261294 | Mark A Ellis, Md, PC | Anesthesiology | 1500 Langford Medical Drive, Suite 200, Bogart, GA 30622-6220 | 2006-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780108266 | Catherine Colquitt | Specialist/Technologist | 1081 Rocky Branch Rd, Bogart, GA 30622 | 2017-07-27 |
| 1154864775 | Hampton Valley Health Center, Inc. | Chiropractor | 2881 Monroe Highway, Suite 701, Bogart, GA 30622 | 2016-11-30 |
| 1740298728 | Thomas W Mccormack Jr. | Psychiatry & Neurology | 1361 Jennings Mill Road, Building 200 Suite 201, Bogart, GA 30622 | 2006-08-04 |
| 1659308872 | Blue Laser Group | Ophthalmology | 1747 Langford Drive, Building 400, Suite 101, Bogart, GA 30622 | 2006-06-26 |
| 1225076821 | Pruitthealth Hospice, Inc. | Hospice Care, Community Based | 1751 Meriweather Dr, Bogart, GA 30622 | 2006-06-03 |
| 1205837374 | Terrance L Hughes | Specialist | 1500 Langford Medical Dr., Bldg 200, Bogart, GA 30622 | 2005-08-10 |
| 1922590892 | Inside Out Therapy Services | Occupational Therapist | 1450 Eden Ave, Bogart, GA 30622 | 2018-06-05 |
| 1083736961 | Edward J Fisher Jr Md Inc | Psychiatry & Neurology | 1361 Jennings Mill Rd, Bldg 200 Ste 201, Bogart, GA 30622 | 2007-04-04 |
| 1760504641 | Andrew Philip Heidesch | Marriage & Family Therapist | 1361 Jennings Mill Road, Suite 201, Bogart, GA 30622 | 2007-04-04 |
| 1629109863 | Deborah C Miller | Registered Nurse | 1361 Jennings Mill Road, Building 200 Suite 201, Bogart, GA 30622 | 2007-03-08 |
| Find all providers in zip 30622 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598300782 | Erin Michele Graham | Nurse Practitioner | 1561 Lenru Rd Ste A, Bogart, GA 30622-3334 | 2019-11-12 |
| 1528340056 | Shuconda Sturdivant | Nurse Practitioner | 248 Bob Wages Rd, Bogart, GA 30622-2996 | 2011-09-11 |
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| 1780285486 | Aprn Mobile Clinic LLC | Nurse Practitioner | 1361 Highwoods Pass, Grovetown, GA 30813-3994 | 2020-11-08 |
| 1093316820 | Odyne Rose Lacossiere-dorvilus | Nurse Practitioner | 30 Myrtlewood Dr, Savannah, GA 31405-1024 | 2020-11-06 |
| 1104427061 | Tya Wright | Nurse Practitioner | 1450 Newnan Crossing Blvd E Apt 13205, Newnan, GA 30265-0027 | 2020-11-05 |
| 1235730409 | Cheryl Lynn Williams | Nurse Practitioner | 282 Somerset Dr, Dallas, GA 30132-9761 | 2020-11-04 |
| 1033710298 | Karen F Frazier | Nurse Practitioner | 6610 Crest Wood Ln, Douglasville, GA 30135-9046 | 2020-11-04 |
| 1619578986 | Marjorie Sewannyana | Nurse Practitioner | 553 Camano Way, Mcdonough, GA 30253-8377 | 2020-11-03 |
| 1639770027 | Markesha Leshea Groomes | Nurse Practitioner | 209 N. Cuthbert, Colquitt, GA 39837-3515 | 2020-11-03 |
| 1265033625 | Ashley Thomas | Nurse Practitioner | 3750 Venture Dr Ste E4, Duluth, GA 30096-1863 | 2020-11-03 |
| 1558962894 | Anna Marie Kodama | Nurse Practitioner | 462 Furys Ferry Rd # C, Augusta, GA 30907-9506 | 2020-11-03 |
| 1093315848 | Tracy Tarvers | Nurse Practitioner | 129 Wolf Creek Dr N, Macon, GA 31210-9002 | 2020-10-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.