Justin Edward Wagnon, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN217684 Issued in GA

Practice address

415 E 4TH Ave Ste C
Cordele, GA 31015-0614

Phone

(229) 273-9320

NPI assigned

Apr 30, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

N.T. Cardiovascular Center, PCGroup PAC ID 7618034265, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Crisp Regional Hospital Hospital, Cordele, GA, CCN 110104
• Tift Regional Medical Center Hospital, Tifton, GA, CCN 110095

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DDDGAA
• FHIR API: https://fhir4.healow.com/fhir/r4/IEBJDD/Endpoint/IEBJDD

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.

• N.T. Cardiovascular Center, PC

  • Cardiovascular Disease Physician
  • Perry, GA
  • NPI 1437399276
  Medicare reassignment Care Compare group NPD
• 4U Healthcare LLC

  • Adult Health Nurse Practitioner
  • Cordele, GA
  • NPI 1659169175
  Medicare reassignment NPD
• Georgia Cardiology Center, LLC

  • Cardiovascular Disease Physician
  • Macon, GA
  • NPI 1619992138
  NPD (past)
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)
• Renal Physicians of Georgia PC

  • Nephrology Physician
  • Macon, GA
  • NPI 1851392476
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Crisp Regional Hospital Inc

  • General Acute Care Hospital
  • Cordele, GA
  • NPI 1700851649
  Care Compare affiliation
• Tift Regional Health System Inc.

  • General Acute Care Hospital
  • Tifton, GA
  • NPI 1962462226
  Care Compare affiliation

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1295112183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E 4TH AVE",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153262",
            "telephone_number": "229-273-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E 4TH AVE STE C",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310150614",
            "telephone_number": "229-273-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNON",
        "first_name": "JUSTIN",
        "middle_name": "EDWARD",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-30",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN217684",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN217684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan G Velazquez, D.O.
• Mansi Verma, DMD
• Christina Vinyard
• Teddi Virgil, MD
• Vna of Cordele, Inc.
• Wal-Mart Stores East LP
• Wal-Mart Stores Easts, LP.
• Elisabeth R Waldrip, DMD
• Walgreen Co
• Alexandria Wallace, HAD

• Adult Health Nurse Practitioner in Cordele, GA
• Providers in Cordele, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.