NPIMap

Individual provider Active NPI

Wayne E Parrish, PA C

  • Physician Assistant
  • Moultrie, GA
National Provider Identifier
1104819523
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002606 Issued in GA
Practice address
1414 S Main St
Moultrie, GA 31768-5812
Phone
(229) 985-8713
Fax
(229) 985-5013
NPI assigned
Aug 31, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002606 GA Primary

Addresses

Primary practice location

1414 S Main St
Moultrie, GA 31768-5812

Mailing address

1414 S Main St
Moultrie, GA 31768-5812
Phone (229) 985-8713

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040324000774 GA Practitioner - Physician Assistant 7517858871 Reassigns benefits to 2 organizations
I20110511000508 TN Practitioner - Physician Assistant 7517858871 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
810TNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Colquitt Regional Medical Center CurrentSince Feb 6, 2004 Accepting new patients
Colquitt Regional Medical Center CurrentSince Feb 6, 2004 Accepting new patients
Clubview Emergency Physicians Past Accepting new patients
D.W. Adcock Orthopaedic Clinic, LLC Past Accepting new patients
South Ga Gastroenterology & Nutrition Support, Inc. Past Accepting new patients
Colquitt Regional Orthopedics, LLC Past Accepting new patients
S R Adcock MD PC Past Accepting new patients
Hargrave Emergency Physicians LLC Physician Assistant Past Accepting new patients

Locations

3131 Thomasville Hwy
Moultrie, GA 31768
Phone (229) 502-9769

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104819523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685812",
            "telephone_number": "229-985-8713",
            "fax_number": "229-985-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685812",
            "telephone_number": "229-985-8713",
            "fax_number": "229-985-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARRISH",
        "first_name": "WAYNE",
        "middle_name": "E",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.