Addis Daniel Windham, MD
Individual provider Active NPI Diagnostic Radiology Physician · Sautee, GA
NPI 1184884793 · NPPES record last updated Jun 17, 2008
Key facts
- NPI
- 1184884793
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 013810 (GA)
- Practice address
- 253 Garland Bristol Rd
Sautee, GA 30571-2703 - Phone
- (706) 878-2664
- Fax
- (706) 878-2664
- NPI assigned
- Jun 17, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013810 | GA | MD | Diagnostic Radiology Physician |
| 13810 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Valley Medical Center | Past | Accepting new patients | |
| Health First | Past | Accepting new patients |
Interoperability endpoints
- https://epicproxy.et1426.epichosted.com/FHIRProxyPRD/api/FHIR/R4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 013810 | GA | Yes |
Addresses
Primary practice location
253 Garland Bristol Rd
Sautee, GA 30571-2703
Mailing address
253 Garland Bristol Road
Sautee, GA 30571-2703
Phone (706) 878-2664
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300108014 | Other | RAILROAD MEDICARE | |
| 000073169D | Medicaid | GA |
Other providers in Sautee, GA
- Black Bear Treatment Center LLC
- Haley Brown
- Ecumenical Christian Wellness Ministries
- Recovery Physician Group of Georgia, LLC
- Melissa Lee Warner
All providers in Sautee, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.