NPIMap

Individual provider Active NPI

Ethan Jacob Wajswol, MD (5/18/2020)

  • Urology Physician
  • Canton, GA
National Provider Identifier
1366076945
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
99892 Issued in GA
Practice address
470 Northside Cherokee Blvd Ste 201
Canton, GA 30115-8029
Phone
(770) 720-7246
Fax
(770) 720-4620
NPI assigned
Feb 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 99892 GA Primary

Addresses

Primary practice location

470 Northside Cherokee Blvd Ste 201
Canton, GA 30115-8029

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310
Phone (678) 284-4040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240926003827 FL Practitioner - Urology 2466875133 Reassigns benefits to 1 organization
I20250509003184 GA Practitioner - Urology 2466875133 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Urology, PA Urology CurrentSince Jul 1, 2025 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Sep 1, 2024 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Sep 1, 2024 Accepting new patients
Urological Professional Services, LLC Urology CurrentSince Jul 1, 2025 Accepting new patients
Georgia Urology, PA CurrentSince Jul 1, 2025 Accepting new patients
Georgia Urology PA Urology Current Accepting new patients

Locations

4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815

4450 Calibre Xing NW
Acworth, GA 30101
Phone (770) 607-1893

100 Liberty Blvd
Ste 230
Canton, GA 30114
Phone (678) 593-1043

100 Liberty Blvd
Ste 240
Canton, GA 30114
Phone (678) 593-1043

470 Northside Cherokee Blvd
Ste 201
Canton, GA 30115
Phone (770) 720-7246

9 Medical Dr NE
Ste A
Cartersville, GA 30121
Phone (770) 607-1893

1930 Brannan Rd
McDonough, GA 30253
Phone (678) 284-4040

4298 Atlanta Rd SE
Ste 305
Smyrna, GA 30080
Phone (678) 284-4040

900 Towne Lake Pkwy
Ste 200
Woodstock, GA 30189
Phone (678) 494-9201

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: ethan.wajswol.p1@direct.gupa.nextgenshare.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 5

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

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Rutgers New Jersey Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Jacksonville 1,595 clinicians
Georgia Urology, PA 99 clinicians
Urological Professional Services, LLC 72 clinicians

Practice addresses (Care Compare)

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

470 Northside Cherokee Blvd
Suite 201
Canton, GA 30115-8015
Phone (770) 720-7246

Hospital & facility affiliations

  • Piedmont Cartersville Medical Center Hospital, Cartersville, GA, CCN 110030
  • Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Mayo Clinic Hospital, Jacksonville, FL, CCN 100151
  • Piedmont Mountainside Hospital Inc Hospital, Jasper, GA, CCN 110225

Merit-based Incentive Payment System (MIPS)

Final score
84.24 of 100Reported as group
Quality
74.85
Promoting interoperability
100
Improvement activities
40
Cost
72.62

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

NPI Registry JSON

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1366076945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 BRANNAN RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534310",
            "telephone_number": "678-284-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 NORTHSIDE CHEROKEE BLVD STE 201",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158029",
            "telephone_number": "770-720-7246",
            "fax_number": "770-720-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAJSWOL",
        "first_name": "ETHAN",
        "middle_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "MD (5/18/2020)",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-24",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "99892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.