NPIMap

Individual provider Active NPI

Seth T Wagner, D.O.

  • Internal Medicine Physician
  • Dalton, GA
National Provider Identifier
1659506277
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
070602 Issued in GA
Practice address
1114 Professional Blvd
Dalton, GA 30720
Phone
(706) 278-0138
Fax
(706) 272-3780
NPI assigned
May 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 070602 GA
Hospitalist Physician 208M00000X D02265 TN
Internal Medicine Physician 207R00000X 070602 GA Primary

Addresses

Primary practice location

1114 Professional Blvd
Dalton, GA 30720

Mailing address

1114 Professional Blvd
Dalton, GA 30720
Phone (706) 278-0138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130930000405 GA Practitioner - Internal Medicine 4385880095 Reassigns benefits to 2 organizations
I20160606000537 TN Practitioner - Internal Medicine 4385880095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dalton Family Practice, P.C.Group PAC ID 6103817572, 8 clinicians

Practice addresses (Care Compare)

1114 Professional Blvd
Dalton, GA 30720-2588
Phone (706) 278-0138

Hospital & facility affiliations

  • Hamilton Home Health Home health agency, Dalton, GA, CCN 117062
  • North Georgia Home Health Agency, an Amedysis Comp Home health agency, Ringgold, GA, CCN 117028
  • Adoration Home Health Home health agency, Ringgold, GA, CCN 117308
  • Hamilton Medical Center Hospital, Dalton, GA, CCN 110001
  • Memorial Healthcare System, Inc Hospital, Chattanooga, TN, CCN 440091

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2265TNMDOptometrist
070602GAMDInternal Medicine Physician
D02265TNMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hamilton Medical Center, Inc. CurrentSince Feb 1, 2016 Accepting new patients
Chattanooga Hamilton County Hospital Authority CurrentSince Jun 1, 2016 Accepting new patients
Dalton Family Practice, P.C. CurrentSince Jan 1, 2017 Accepting new patients
Chattanooga Hamilton County Hospital Authority CurrentSince Jun 1, 2016 Accepting new patients
Chattanooga Hamilton County Hospital Authority Internal Medicine Current Accepting new patients
Hamilton Physician Group Inc CurrentSince Feb 1, 2016 Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

1114 Professional Blvd
Dalton, GA 30720
Phone (706) 278-0138

100 Gross Crescent Cir
Ft Oglethorpe, GA 30742
Phone (706) 858-2301

975 E 3rd St
Chattanooga, TN 37403
Phone (423) 266-1499

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1243382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1659506277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-278-0138",
            "fax_number": "706-272-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-278-0138",
            "fax_number": "706-272-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SETH",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-27",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "070602",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": "D02265",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "070602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

Verify at the official NPI Registry.