Wandle Keith Butler, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003196 Issued in GA

Practice address

306 Westside Dr
Douglas, GA 31533-3530

Phone

(912) 383-7826

Fax

(912) 383-7299

NPI assigned

Apr 11, 2007

Last updated

Nov 9, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psych Practice LLC

  • Community/Behavioral Health Agency
  • Douglas, GA
  • NPI 1689060790
  NPD (past)

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1689897209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 SHIRLEY AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332002",
            "telephone_number": "912-260-1206",
            "fax_number": "912-383-7820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WESTSIDE DR",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333530",
            "telephone_number": "912-383-7826",
            "fax_number": "912-383-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "WANDLE",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100000954C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan W Bryant, NP
• Jayla Snipes Bullock, SLP
• Kristin Margie Burnam, FNP-C
• Isadora Burnham, LMFT
• Ashli Nicole Bussey
• Marie W Cadden, LCSW
• Mary Ann Camp, FNP-C
• Care Medical Center LLC
• Care Medical Center LLC
• Carewell Home Health Agency LLC (CareWell Home Health Agency)

• Physician Assistant in Douglas, GA
• Providers in Douglas, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.