Active NPI
John Thomas Wynne, PHARMACIST
- Pharmacist
- Augusta, GA
National Provider Identifier
1568578565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11078
- Practice address
- 1 Freedom Way
Augusta, GA 30904-6258 - Phone
- (706) 733-0188
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11078 | GA | Primary |
Addresses
Primary practice location
1 Freedom Way
Augusta, GA 30904-6258
Mailing address
4046 Goshen Lake Dr S
Augusta, GA 30906-9109
Phone (706) 790-8630
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11078 | GA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568578565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4046 GOSHEN LAKE DR S",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309069109",
"telephone_number": "706-790-8630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 FREEDOM WAY",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309046258",
"telephone_number": "706-733-0188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNNE",
"first_name": "JOHN",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "11078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.