North Fulton Primary Care - Wylie Bridge, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTH FULTON PRIMARY CARE - WYLIE BRIDGE, LLC

Practice address

14205 Highway 92
Suite 105
Woodstock, GA 30188-7138

Phone

(678) 293-7854

Fax

(770) 740-8503

NPI assigned

Aug 28, 2013

Last updated

Jun 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Wesley O. James

Title

Regional Cfo, Tenet

Phone

(404) 265-5009

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1326472283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742595",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742595",
            "telephone_number": "678-293-7854",
            "fax_number": "770-740-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14205 HIGHWAY 92",
            "address_2": "SUITE 105",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301887138",
            "telephone_number": "678-293-7854",
            "fax_number": "770-740-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FULTON PRIMARY CARE - WYLIE BRIDGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "REGIONAL CFO, TENET",
        "authorized_official_telephone_number": "404-265-5009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• North Georgia Oral Surgery, P.C.

• Family Medicine Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.