NPIMap

Organization Active NPI

Waddell Center Family Medicine

  • Family Medicine Physician
  • Athens, AL
National Provider Identifier
1104353226
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WADDELL CENTER FAMILY MEDICINE
Practice address
902 W Washington St
Athens, AL 35611-2438
Phone
(256) 216-9777
Fax
(256) 216-9776
NPI assigned
May 19, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sebrina B Holt
Title
Executive Director
Phone
(256) 216-9648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

902 W Washington St
Athens, AL 35611-2438

Mailing address

902 W Washington St
Athens, AL 35611-2438
Phone (256) 216-9777

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170706002696 AL Part B Supplier - Clinic/Group Practice 3577832542 Receives reassigned benefits from 5 practitioners
Practice locations: Athens, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1104353226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 W WASHINGTON ST",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356112438",
            "telephone_number": "256-216-9777",
            "fax_number": "256-216-9776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W WASHINGTON ST",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356112438",
            "telephone_number": "256-216-9777",
            "fax_number": "256-216-9776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADDELL CENTER FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-19",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "SEBRINA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "256-216-9648"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.