Carl Anthony Wardlaw, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LPC005881 Issued in GA

Practice address

508 Donovan St
Vidalia, GA 30474-3149

Phone

(912) 537-9280

Fax

(912) 537-6289

NPI assigned

Feb 17, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Tony Wardlaw Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266364800000",
    "number": "1326360462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 178",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304750178",
            "telephone_number": "912-537-9280",
            "fax_number": "912-537-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 DONOVAN ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743149",
            "telephone_number": "912-537-9280",
            "fax_number": "912-537-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDLAW",
        "first_name": "CARL",
        "middle_name": "ANTHONY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-17",
        "last_updated": "2010-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC005881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TONY",
            "last_name": "WARDLAW",
            "credential": "LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Counselor in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.