Organization Active NPI

Mary Elizabeth Wiles, DO, PC

  • Internal Medicine Physician
  • Blairsville, GA
National Provider Identifier
1588082465
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARY ELIZABETH WILES, DO, PC
Practice address
374A Pat Haralson Dr
Blairsville, GA 30512-8409
Phone
(706) 745-5541
NPI assigned
Mar 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Authorized official

Name
Dr. Mary Elizabeth Wiles, DO
Title
Ceo
Phone
(706) 745-5541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

374A Pat Haralson Dr
Blairsville, GA 30512-8409

Mailing address

PO Box 1000
Blairsville, GA 30514-1000
Phone (706) 745-5541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140715000525 GA Part B Supplier - Clinic/Group Practice 2668697269 Receives reassigned benefits from 3 practitioners
Practice locations: Blairsville, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2077344Mary Elizabeth Wiles, DO, PC374A Pat Haralson Dr, Blairsville, GA 30512Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1588082465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305141000",
            "telephone_number": "706-745-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374A PAT HARALSON DR",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305128409",
            "telephone_number": "706-745-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ELIZABETH WILES, DO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-745-5541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blairsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.