NPIMap

Individual provider Active NPI

Robert W Wetherington, MD

  • Dermatopathology (Pathology) Physician
  • Smyrna, GA
National Provider Identifier
1285613307
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X
License
044376 Issued in GA
Practice address
2000 Lake Park Dr SE
Smyrna, GA 30080-7611
Phone
(678) 556-9411
Fax
(678) 556-9413
NPI assigned
Jan 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X 044376 GA
Dermatopathology (Pathology) Physician 207ZD0900X 044376 GA Primary
Anatomic Pathology Physician 207ZP0101X 044376 GA

Addresses

Primary practice location

2000 Lake Park Dr SE
Smyrna, GA 30080-7611

Mailing address

P.O. Box 3429
Augusta, GA 30914-3429
Phone (706) 737-4575

Other identifiers 2

IdentifierTypeStateIssuer
000968019BMedicaidGA
272341992OtherTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jack H. Austin, Jr., MD, PC Past Accepting new patients
Ocmulgee Medical Pathology Association, Inc Past Accepting new patients

Organizations & group practices 2

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1285613307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 3429",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309143429",
            "telephone_number": "706-737-4575",
            "fax_number": "706-731-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 LAKE PARK DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300807611",
            "telephone_number": "678-556-9411",
            "fax_number": "678-556-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETHERINGTON",
        "first_name": "ROBERT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "GA",
            "license": "044376",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "GA",
            "license": "044376",
            "primary": true
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "GA",
            "license": "044376",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968019B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "272341992",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.