Individual provider Active NPI

Angela C Wooley, MSN, FNP-BC

  • Nurse Practitioner
  • Pooler, GA
National Provider Identifier
1225209901
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN115523 Issued in GA
Practice address
1000 Towne Center Blvd Ste 301
Pooler, GA 31322-4068
Phone
(912) 644-4900
NPI assigned
Mar 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN115523 GA Primary

Addresses

Primary practice location

1000 Towne Center Blvd Ste 301
Pooler, GA 31322-4068

Mailing address

1000 Towne Center Blvd Ste 301
Pooler, GA 31322-4068
Phone (912) 644-4900

Other identifiers 3

IdentifierTypeStateIssuer
553125979AMedicaidGA
RN115523OtherGAGEORGIA NP LICENSE
01182119OtherGAAMERIGROUP

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080520000144 GA Practitioner - Nurse Practitioner 4183793946

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN115523GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Candler Urgent Care Centers LLC CurrentSince May 1, 2019 Accepting new patients
St Josephs Candler Urgent Care Centers LLC CurrentSince May 1, 2019 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients
Privia Medical Group, LLC PastSince Feb 4, 2024 Accepting new patients

Locations

101 Saint Josephs Candler Dr
Ste 100
Pooler, GA 31322
Phone (912) 450-1945

107 Canal St
Pooler, GA 31322
Phone (912) 450-1945

361 Commercial Dr
Savannah, GA 31406
Phone (912) 355-6221

361 Commercial Dr
#F
Savannah, GA 31406
Phone (912) 355-2400

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1225209901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD STE 301",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224068",
            "telephone_number": "912-644-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD STE 301",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224068",
            "telephone_number": "912-644-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOLEY",
        "first_name": "ANGELA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-20",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN115523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "553125979A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA NP LICENSE",
            "identifier": "RN115523",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01182119",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

Verify at the official NPI Registry.