Individual provider Active NPI

David Wicker, M.D.

  • Diagnostic Radiology Physician
  • Atlanta, GA
National Provider Identifier
1124205356
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
002125 Issued in GA
Practice address
1364 Clifton Rd NE
Radiology RM D125A
Atlanta, GA 30322-1059
Phone
(404) 712-4686
NPI assigned
Jan 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 002125 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Radiology RM D125A
Atlanta, GA 30322-1059

Mailing address

422 Lantern Wood Dr
Scottdale, GA 30079-6802

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000655 GA Practitioner - Diagnostic Radiology 0840315503 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Georgia School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of North GeorgiaGroup PAC ID 2769715044, 36 clinicians
Athens Radiology Associates PCGroup PAC ID 2860486107, 34 clinicians

Practice addresses (Care Compare)

1199 Prince Ave
Athens, GA 30606-2797
Phone (706) 475-7000

1230 Baxter St
Athens, GA 30606-3712
Phone (706) 548-7581

Hospital & facility affiliations

  • Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074
  • St Mary'S Hospital Hospital, Athens, GA, CCN 110006
  • St Marys Good Samaritan Hospital Hospital, Greensboro, GA, CCN 111329
  • Piedmont Walton Hospital Hospital, Monroe, GA, CCN 110046
  • Ty Cobb Regional Medical Center, LLC Hospital, Lavonia, GA, CCN 110027

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
002125GAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Synergy Radiology, LLC CurrentSince Jun 9, 2022 Accepting new patients
M & B Imaging, PC Diagnostic Radiology CurrentSince Jan 22, 2022 Accepting new patients
Athens Radiology Associates PC Diagnostic Radiology CurrentSince Jul 1, 2010 Accepting new patients
Radiology Associates of North Georgia Diagnostic Radiology CurrentSince May 1, 2018 Accepting new patients
American Health Imaging of Georgia, LLC CurrentSince Dec 31, 2021 Accepting new patients
Synergy Radiology, LLC Diagnostic Radiology CurrentSince Jun 9, 2022 Accepting new patients
American Health Imaging of Georgia LLC CurrentSince May 1, 2022 Accepting new patients

Locations

1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520

1230 Baxter St
Athens, GA 30606
Phone (706) 364-3100

1501 Milstead Rd NE
Ste 140
Conyers, GA 30012

6025 Professional Pkwy
Ste 104
Douglasville, GA 30134
Phone (770) 444-9981

9459 Highway 5
Ste R
Douglasville, GA 30135

5401 Lake Oconee Pkwy
Greensboro, GA 30642
Phone (706) 453-7331

367 Clear Creek Pkwy
Lavonia, GA 30553
Phone (706) 356-7800

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

1305 Jennings Mill Rd
Ste 130
Watkinsville, GA 30677
Phone (706) 475-6881

Organizations & group practices 7

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201651200000",
    "number": "1124205356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 LANTERN WOOD DR",
            "city": "SCOTTDALE",
            "state": "GA",
            "postal_code": "300796802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "address_2": "RADIOLOGY RM D125A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221059",
            "telephone_number": "404-712-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKER",
        "first_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "002125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.