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1417944513

NPI Code Detail

MEDICARE: DR. JOSE MEDINA MD

MEDICARE: DR. JOSE MEDINA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	041166	GA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	041166	GA
3	207RP1001X	Pulmonary Disease Physician	041166	GA
4	207RS0012X	Sleep Medicine (Internal Medicine) Physician	041166	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417944513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MEDINA MD

Provider Business Mailing Address
First Line	:	PO BOX 3550
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31604-3550
Country	:	US
Telephone Number	:	229-247-1667
Fax Number	:	229-245-7661

Provider Business Practice Location Address
First Line	:	3334 GREYSTONE WAY
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605
Country	:	US
Telephone Number	:	229-247-1667
Fax Number	:	229-245-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/19/2012

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Directions to “ DR. JOSE MEDINA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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