Georgia Wagner, MA,RD,CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

37000770A Issued in IN

Practice address

1941 Virginia Ave
Connersville, IN 47331-2833

Phone

(765) 825-5131

Fax

(765) 827-7863

NPI assigned

May 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1295146165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 VIRGINIA AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473312833",
            "telephone_number": "765-825-5131",
            "fax_number": "765-827-7863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 VIRGINIA AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473312833",
            "telephone_number": "765-825-5131",
            "fax_number": "765-827-7863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GEORGIA",
        "credential": "MA,RD,CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "37000770A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andy Tran, MD
• Transportation Services Ventures Inc. (Handy Van Medical Transport)
• Trinity Mission Health & Rehab of Connersville, LP (Caroleton Manor)
• Usha Patel MD
• Billie Jean Varner
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1729)
• Wal-Mart Stores East. LP (Walmart Vision Center 30-1729)
• Gary E Weber
• Macie Weiler
• Matthew Westenfeld

• Registered Dietitian in Connersville, IN
• Providers in Connersville, IN by specialty
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; 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.