Active NPI
Sanna Rose Wagner, CNM
- Advanced Practice Midwife
- Dalton, GA
National Provider Identifier
1013053222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- R039268
- Practice address
- 1525 Chattanooga Rd
Dalton, GA 30720-8379 - Phone
- (706) 226-3373
- Fax
- (706) 226-0845
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | R039268 | GA | Primary |
Addresses
Primary practice location
1525 Chattanooga Rd
Dalton, GA 30720-8379
Mailing address
1525 Chattanooga Rd
Dalton, GA 30720-8379
Phone (706) 226-3373
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00369619A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R039268 | GA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294099200000",
"number": "1013053222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 CHATTANOOGA RD",
"city": "DALTON",
"state": "GA",
"postal_code": "307208379",
"telephone_number": "706-226-3373",
"fax_number": "706-226-0845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 CHATTANOOGA RD",
"city": "DALTON",
"state": "GA",
"postal_code": "307208379",
"telephone_number": "706-226-3373",
"fax_number": "706-226-0845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SANNA",
"middle_name": "ROSE",
"name_prefix": "Ms.",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2011-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "GA",
"license": "R039268",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00369619A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dalton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.