Individual provider Active NPI

Laurel Dana Wartenberg, DO

  • Family Medicine Physician
  • Augusta, GA
National Provider Identifier
1154007110
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15150 Issued in GA
Practice address
1417 Pendleton Rd
Augusta, GA 30904
Phone
(706) 738-9824
NPI assigned
Jun 26, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 15150 GA Primary

Addresses

Primary practice location

1417 Pendleton Rd
Augusta, GA 30904

Mailing address

1120 15TH Street
Dept. of Family and Community Medicine, Hb3000E
Augusta, GA 30912

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
I20230718001597 GA Order and Referring Only - Family PracticePractitioner - Family Practice 5597125831

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": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1154007110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 15TH STREET",
            "address_2": "DEPT. OF FAMILY AND COMMUNITY MEDICINE, HB3000E",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 PENDLETON RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30904",
            "telephone_number": "706-738-9824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARTENBERG",
        "first_name": "LAUREL",
        "middle_name": "DANA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "15150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.