Individual provider Active NPI

Nathan A. Wilson, M.D.

  • Pediatrics Physician
  • Augusta, GA
National Provider Identifier
1386727006
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
057203 Issued in GA
Practice address
3485 Mike Padgett Hwy
Augusta, GA 30906-3815
Phone
(706) 771-7843
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 057203 GA Primary

Addresses

Primary practice location

3485 Mike Padgett Hwy
Augusta, GA 30906-3815

Mailing address

6531 River Bluff TRL
Martinez, GA 30907-3317
Phone (706) 831-5834

Other identifiers 1

IdentifierTypeStateIssuer
597935080AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL augusta

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211007000233 GA Practitioner - Pediatric Medicine 8628476520 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
057203GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2023 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Au Medical Associates Inc CurrentSince Sep 1, 2021 Accepting new patients
Au Medical Associates Inc CurrentSince Sep 1, 2021 Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1386727006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6531 RIVER BLUFF TRL",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309073317",
            "telephone_number": "706-831-5834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-771-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NATHAN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "057203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597935080A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "augusta",
            "affiliation": "N",
            "address_1": "3485 Mike Padgett Hwy",
            "city": "Augusta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "309063815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.