Edgar Wollam

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

19436 Issued in GA

Practice address

1660 Mulkey Rd
Ste B
Austell, GA 30106

Phone

(678) 460-2700

Fax

(770) 739-0212

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Other names 1

• Gary Wollam Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BCHBDA

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.

• Cobb Nephrology Hypertension Associates, PC

  • Nephrology Physician
  • Austell, GA
  • NPI 1821036278
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1316978166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 MULKEY RD",
            "address_2": "STE B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "30106",
            "telephone_number": "678-460-2700",
            "fax_number": "770-739-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 MULKEY RD",
            "address_2": "STE B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "30106",
            "telephone_number": "678-460-2700",
            "fax_number": "770-739-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLAM",
        "first_name": "EDGAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "19436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "920632",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001416187H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110059639",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "356860",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "581992673003",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000146187G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "03169",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GARY",
            "last_name": "WOLLAM",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nicole Dubois Witt, AGACNP-BC
• Nega Woldehawariat, M.D.
• Patricia Anne Wolfe, D.O.
• Melissa Wolff, PAAA
• Michael H Wolff, MD
• Kylie Elizabeth Womack, OTR/L
• Taurus Rafeal Womble, NP-C
• Women'S Healthcare Center of Georgia
• Vivian Gu Woo
• Aisha Oseye Woodard-Redmond, MD

• Nephrology Physician in Austell, GA
• Providers in Austell, GA by specialty
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.