Peyton Waggener

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

APC007217 Issued in GA

Practice address

1814 Clairmont Rd
Decatur, GA 30033-3405

Phone

(404) 636-1457

Fax

(404) 636-7449

NPI assigned

Dec 12, 2019

Last updated

Dec 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 25, 2024 through Feb 25, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1649818410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333405",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333405",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 Hugh Howell Rd",
            "address_purpose": "LOCATION",
            "city": "Stone Mountain",
            "state": "GA",
            "postal_code": "300872402",
            "country_code": "US",
            "telephone_number": "404-636-1457 x420",
            "fax_number": "404-636-1457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGGENER",
        "first_name": "PEYTON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-12",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC007217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwan Wade
• Nancy Earline Wade, RN
• Mufida Muradali Wadhwania, M.D.
• Michael Wadleigh
• Monica Maria Wadley
• Amanda Kay Wagner, LCSW
• Matthew Wagner, LPC, CAADC
• Tricia Francisco Wagner
• Kristen Wagoner, LPC
• Abdul Wahab, PHD

• Professional Counselor in Decatur, GA
• Providers in Decatur, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.