MARK THOMAS BRULTE (NPI# 1205931672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205931672 |
| Entity Type | Individual |
| Full Name | MARK THOMAS BRULTE |
| Credential | MD |
| Practice Address |
200 Doctors Dr Suite 106 Douglas GA 31533-2201 |
| Practice Telephone | 9123843338 |
| Practice Fax Number | 9123890979 |
| Mailing Telephone | 9123843338 |
| Mailing Fax Number | 9123890979 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2010-12-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 048490 | GA | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | 048490 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00873441A | 05 | |
| GA | WELLCARE-NICHOLLS | 543782 | 01 |
| GA | 000873441H | 05 | |
| GA | WELLCARE-DOUGLAS | 478042 | 01 |
| GA | MEDICARE GROUP # | GRP7301 | 01 |
| GA | WELLCARE-WILLACOOCHEE | 541189 | 01 |
| GA | 000873441I | 05 | |
| GA | PEACHSTATE | 128214 | 01 |
| GA | 0008734441F | 05 |
| Street Address |
200 DOCTORS DR SUITE 106 |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750374294 | Hemachandran P Nair | Internal Medicine | 200 Doctors Dr, Suite 106, Douglas, GA 31533-2201 | 2005-08-30 |
| 1760856405 | Crh Physician Practices LLC | General Practice | 200 Doctors Dr, Suite S, Douglas, GA 31533-2201 | 2015-11-18 |
| 1063832731 | Larissa Davis | Nurse Practitioner | 200 Doctors Dr, Ste 201, Douglas, GA 31533-2201 | 2014-04-22 |
| 1417388687 | Crh Physician Practices, LLC | Psychiatry & Neurology | 200 Doctors Dr, Suite L, Douglas, GA 31533-2201 | 2013-12-12 |
| 1417396342 | Joi Livingston Rogers | Pediatrics | 200 Doctors Dr, Suite 201, Douglas, GA 31533-2201 | 2013-06-25 |
| 1477997278 | Phoebe Family Medicine,coffee County | Clinic/Center | 200 Doctors Dr, Ste 224, Douglas, GA 31533-2201 | 2013-04-23 |
| 1255682142 | Crh Physician Practices LLC | Pediatrics | 200 Doctors Dr, Ste 201, Douglas, GA 31533-2201 | 2012-10-02 |
| 1417207796 | Crh Physician Practices LLC | Urology | 200 Doctors Dr, Ste 220, Douglas, GA 31533-2201 | 2012-09-14 |
| 1427305507 | Debra Sharon Luke | Nurse Practitioner | 200 Doctors Dr, Suite 106, Douglas, GA 31533-2201 | 2012-08-08 |
| 1669745345 | South Georgia Eye Partners PC | Optometrist | 200 Doctors Dr, Suite 290, Douglas, GA 31533-2201 | 2012-02-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1952940793 | Teresa Smith | Pharmacist | 901 W Ward St, Douglas, GA 31533 | 2019-12-26 |
| 1447641048 | Jennifer Spivey | Nurse Practitioner | 326 Shirley Avenue, Douglas, GA 31533 | 2015-02-18 |
| 1972914497 | Jessica Lynne Courson | Nurse Practitioner | 903 West Ward Street, Suite B, Douglas, GA 31533 | 2014-05-19 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 1336411008 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 Coweta Avenue South, Douglas, GA 31533 | 2012-01-27 |
| 1346482700 | V and V Clinic | Pediatrics | 1020 West Bryan Street, Douglas, GA 31533 | 2009-04-01 |
| 1063650406 | Jayla Snipes Bullock | Speech-Language Pathologist | 618 Bowens Mill Road Sw, Douglas, GA 31533 | 2009-01-22 |
| 1417112707 | Southern Community Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315 S. Gaskin Ave, Douglas, GA 31533 | 2008-07-25 |
| Find all providers in zip 31533 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457722720 | Crh Physician Practices LLC | Internal Medicine | 901 Connector 206 N, Douglas, GA 31533-7150 | 2015-10-13 |
| 1821345356 | Southeastern Neuromuscular Massage Therapy, Inc. | Internal Medicine | 112 Madison Ave N, Douglas, GA 31533-4604 | 2012-08-15 |
| 1619131299 | Jeong Hun Paik | Internal Medicine | 200 Doctors Dr Ste K, Douglas, GA 31533-2202 | 2008-07-14 |
| 1174699649 | Hector F Garcia | Internal Medicine | 1116 N G Ave, Ste. 7, Douglas, AZ 85607-1944 | 2006-11-28 |
| 1013995935 | Krishnan Arunachalam | Internal Medicine | 2012 Ocilla Hwy, Douglas, GA 31533-2232 | 2006-01-03 |
| 1043203425 | Dennis Conrad Harper | Internal Medicine | 1400 N. Peterson Avenue, Suite C, Douglas, GA 31533 | 2005-08-31 |
| 1750374294 | Hemachandran P Nair | Internal Medicine | 200 Doctors Dr, Suite 106, Douglas, GA 31533-2201 | 2005-08-30 |
| 1326031865 | Marshall Glynn Tanner | Internal Medicine | 2016 Ocilla Rd, Douglas, GA 31533-2230 | 2005-08-30 |
| 1437142320 | James Stanley Sinclair | Internal Medicine | 306 Westside Dr, Douglas, GA 31533-3530 | 2005-08-25 |
| 1447250220 | Robert Darrell Collins | Internal Medicine | 1208 Ocilla Rd Unit 1, Douglas, GA 31533-2220 | 2005-07-22 |
| Find all providers in DOUGLAS | ||||
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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.