Active NPI
Wiley Wilson, DO
- Pediatrics Physician
- Cordele, GA
National Provider Identifier
1083686430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036633
- Practice address
- 176 Lakeview Cir
Cordele, GA 31015-5318 - Phone
- (229) 322-0570
- Fax
- (229) 271-7504
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036633 | GA | Primary |
Addresses
Primary practice location
176 Lakeview Cir
Cordele, GA 31015-5318
Mailing address
176 Lakeview Cir
Cordele, GA 31015-5318
Phone (229) 322-0570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 795339666A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252022400000",
"number": "1083686430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "176 LAKEVIEW CIR",
"city": "CORDELE",
"state": "GA",
"postal_code": "310155318",
"telephone_number": "229-322-0570",
"fax_number": "229-271-7504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "176 LAKEVIEW CIR",
"city": "CORDELE",
"state": "GA",
"postal_code": "310155318",
"telephone_number": "229-322-0570",
"fax_number": "229-271-7504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WILEY",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-01",
"last_updated": "2009-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "036633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "795339666A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordele, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.