Individual provider Active NPI

Wayne N Darville, M.D.

  • Pediatrics Physician
  • Calhoun, GA
National Provider Identifier
1477518256
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
029271 Issued in GA
Practice address
204 Professional CT SE
Calhoun, GA 30701-7020
Phone
(706) 625-5900
Fax
(706) 625-5906
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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 029271 GA Primary

Addresses

Primary practice location

204 Professional CT SE
Calhoun, GA 30701-7020

Mailing address

204 Professional CT SE
Calhoun, GA 30701-7020
Phone (706) 625-5900

Other identifiers 1

IdentifierTypeStateIssuer
000350237MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
029271GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Agc Pediatrics, LLC Past Accepting new patients
Agc Pediatrics, LLC PastSince Sep 23, 2019 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DEJAAA

Organizations & group practices 2

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1477518256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 PROFESSIONAL CT SE",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307017020",
            "telephone_number": "706-625-5900",
            "fax_number": "706-625-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 PROFESSIONAL CT SE",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307017020",
            "telephone_number": "706-625-5900",
            "fax_number": "706-625-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARVILLE",
        "first_name": "WAYNE",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "029271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000350237",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calhoun, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.