Northeast Georgia Gastroenterology Associates, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

33231 Issued in GA

Legal business name

NORTHEAST GEORGIA GASTROENTEROLOGY ASSOCIATES, PC

Practice address

700 Sunset Dr
Suite 501
Athens, GA 30606-2293

Phone

(706) 208-0065

Fax

(706) 549-8693

NPI assigned

Jan 16, 2007

Last updated

Feb 19, 2010By 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

Dr. Stephen William Wilde, MDNPI 1023002763

Title

President Ceo MD

Phone

(706) 208-0065

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen William Wilde, M.D.

  • Gastroenterology Physician
  • Athens, GA
  • NPI 1023002763
  Authorized official Same address or phone

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266537600000",
    "number": "1427100106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SUNSET DR",
            "address_2": "SUITE 501",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062293",
            "telephone_number": "706-208-0065",
            "fax_number": "706-549-8693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SUNSET DR",
            "address_2": "SUITE 501",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062293",
            "telephone_number": "706-208-0065",
            "fax_number": "706-549-8693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA GASTROENTEROLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-02-19",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT CEO MD",
        "authorized_official_telephone_number": "706-208-0065",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "33231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Athens, GA
• Providers in Athens, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; 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.