Individual provider Active NPI

Wynhdam George Mortimer, MD

  • Anesthesiology Physician
  • Atlanta, GA
National Provider Identifier
1235155367
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
29045 Issued in GA
Practice address
1968 Peachtree Road NW
Atlanta, GA 30309-1281
Phone
(404) 351-1745
Fax
(404) 351-7121
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 29045 GA Primary
Anesthesiology Physician 207L00000X 029045 GA

Addresses

Primary practice location

1968 Peachtree Road NW
Atlanta, GA 30309-1281

Mailing address

PO Box 551420
Fort Lauderdale, FL 33355-1420
Phone (800) 243-3839

Other practice location 1

1265 Highway 54 W Ste 103
Fayetteville, GA 30214-4537
Phone (678) 216-0771

Other practice location 2

1255 Highway 54 W
Fayetteville, GA 30214-4526
Phone (404) 351-1745

Other practice location 3

745 Poplar Rd
Newnan, GA 30265-1618
Phone (770) 400-1000

Other identifiers 1

IdentifierTypeStateIssuer
0035167MedicaidGA

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
I20041214000258 GA Practitioner - Anesthesiology 2769449586 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Ohio State University College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Anesthesia LLCGroup PAC ID 2163837972, 555 clinicians

Practice addresses (Care Compare)

1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085
Phone (800) 242-1131

1968 Peachtree Rd NW
Atlanta, GA 30309-1281
Phone (404) 351-1745

745 Poplar Rd
Newnan, GA 30265-1618
Phone (404) 351-1745

Hospital & facility affiliations

  • Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215
  • Piedmont Hospital, Inc Hospital, Atlanta, GA, CCN 110083

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29045GAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Anesthesia Associates, L.L.C Anesthesiology CurrentSince Jul 1, 1966 Accepting new patients
Piedmont Anesthesia LLC Anesthesiology CurrentSince Mar 8, 2025 Accepting new patients
Fayette Community Anesthesia Anesthesiology Past Accepting new patients
American Anesthesiology Associates of Georgia, LLC Anesthesiology Past Accepting new patients

Locations

1968 Ptree Rd NW
Atlanta, GA 30309
Phone (404) 605-2222

1984 Peachtree Rd NW
Ste 515
Atlanta, GA 30309
Phone (404) 351-1754

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

1265 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-7000

1255 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-6911

1265 Highway 54 W
Ste 103
Fayetteville, GA 30214
Phone (678) 216-0771

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

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.

Hospital & facility affiliations 2

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1235155367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "954-839-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE ROAD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-351-1745",
            "fax_number": "404-351-7121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1265 Highway 54 W Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302144537",
            "country_code": "US",
            "telephone_number": "678-216-0771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1255 Highway 54 W",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302144526",
            "country_code": "US",
            "telephone_number": "404-351-1745",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "745 Poplar Rd",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302651618",
            "country_code": "US",
            "telephone_number": "770-400-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORTIMER",
        "first_name": "WYNHDAM",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "29045",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "029045",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035167",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.