JOHN BURTON DERRICK (NPI# 1932253606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932253606 |
| Entity Type | Individual |
| Full Name | JOHN BURTON DERRICK |
| Practice Address |
300 Arlington Dr Vidalia GA 30474-0645 |
| Mailing Address |
300 Arlington Dr Po Box 645 Vidalia GA 30475 |
| Practice Telephone | 9125380830 |
| Mailing Telephone | 9125380830 |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
01655 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | DEA LICENSE | MD0736504 | 01 |
| GA | LICENSE | 01655 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487768016 | John Derrick | Psychologist | 5106 Federal Blvd, Suite 107, San Diego, CA 92105-5453 | 2006-08-19 |
| 1538598974 | John Derrick | Nurse Practitioner | 13123 E 16th Ave, Children's Hospital Colorado, Aurora, CO 80045-7106 | 2013-11-06 |
| 1730325044 | John Thomas Derrick II | Counselor | 1037 Pathfinder Way Ste 130, Rockledge, FL 32955-3242 | 2008-12-17 |
| Street Address |
300 ARLINGTON DR |
| City | VIDALIA |
| State | GA |
| Zip Code | 30474-0645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609138692 | Mercy Medical Clinic | Clinic/Center | 300 Arlington Dr, Vidalia, GA 30474-8935 | 2012-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730655374 | Abby Virginia Adams | Speech-Language Pathologist | 101 Harris Insustrial Blvd, Vidalia, GA 30474 | 2018-10-22 |
| 1467930156 | Laurel Shiver Sapp | Nurse Practitioner | 1608 Meadows Ln, Vidalia, GA 30474 | 2018-08-03 |
| 1235658931 | Mary Frances Andrews | Nurse Practitioner | 1608 Meadows Lane Suite 1, Vidalia, GA 30474 | 2017-09-13 |
| 1154714574 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 104 Andrews Street, Suite 112, Vidalia, GA 30474 | 2015-03-10 |
| 1790112571 | Tattnall Hospital Company, LLC | Surgery | 1702-a Meadows Lane, Vidalia, GA 30474 | 2013-10-10 |
| 1801235312 | Paul Anderson Youth Home, Inc. | Substance Abuse Rehabilitation Facility | 1603 Mcintosh Street, Vidalia, GA 30474 | 2013-06-18 |
| 1043591076 | Kimberly Thigpen Evans | Nurse Practitioner | 621 East First Street, Unit B, Vidalia, GA 30474 | 2011-09-03 |
| 1154614360 | Tattnall Hospital Company, LLC | Family Medicine | 1811 Edwina Drive, Vidalia, GA 30474 | 2011-05-20 |
| 1255586053 | Vidalia Medical Partners Inc. | Home Health | 801 Mcnatt Street, Vidalia, GA 30474 | 2008-11-20 |
| 1154596419 | Jill Nicole Lawrence | Speech-Language Pathologist | 1400 Ne Main St, Bethany Alf, Vidalia, GA 30474 | 2008-04-28 |
| Find all providers in zip 30474 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928622 | Kennedy Poole | Physician Assistant | 1643 Carter St Ste 1, Vidalia, LA 71373-3157 | 2020-09-28 |
| 1689163685 | Daniel Lauren Dasher | Physician Assistant | 210 Mose Coleman Dr, Vidalia, GA 30474-8677 | 2018-05-04 |
| 1962873711 | Leah M Waller | Physician Assistant | 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 2015-10-19 |
| 1063759744 | Rebecca Arthur Foster | Physician Assistant | 1154 Logan Sewell Dr, Vidalia, LA 71373-3342 | 2013-01-15 |
| 1982698361 | Dustin J Carter | Physician Assistant | 200 Maple Dr, Vidalia, GA 30474-8907 | 2005-08-31 |
| 1265426639 | Robert Lee Arnold | Physician Assistant | 200 Maple Dr, Vidalia, GA 30474-8907 | 2005-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
| 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.