Mitchell Jay Wilson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

061188 Issued in GA

Practice address

707 Old Dalton Ellijay Rd
Chatsworth, GA 30705-2029

Phone

(706) 517-2030

Fax

(706) 517-2076

NPI assigned

Jun 7, 2006

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

University of Texas Medical Branch at Galveston, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Phoebe Physician Group IncGroup PAC ID 8426112350, 420 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Phoebe Putney Memorial Hospital Hospital, Albany, GA, CCN 110007
• Commonspirit-Memorial Hospital-North Georgia Hospital, Ringgold, GA, CCN 110236

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment Care Compare group NPD
• Allatoona Physician Services PC

  • Hospitalist Physician
  • Cartersville, GA
  • NPI 1497482350
  Medicare reassignment NPD
• Anemonefish Inpatient Services LLC

  • Internal Medicine Physician
  • Covington, GA
  • NPI 1033514716
  Medicare reassignment NPD
• Benning Hospitalist Services, LLC

  • Hospitalist Physician
  • Columbus, GA
  • NPI 1215442173
  Medicare reassignment NPD
• Hamilton Medical Center, Inc.

  • General Acute Care Hospital
  • Dalton, GA
  • NPI 1528056066
  Medicare reassignment NPD
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385
  Medicare reassignment NPD
• Muscogee Hospitalist Services, LLC

  • Hospitalist Physician
  • Columbus, GA
  • NPI 1639681851
  Medicare reassignment NPD
• Hamilton Physician Group Inc

  • Cardiovascular Disease Physician
  • Dalton, GA
  • NPI 1235455569
  NPD
• Phoebe Putney Memorial Hospital Inc

  • General Acute Care Hospital
  • Albany, GA
  • NPI 1992789721
  NPD (past)
• Alabama Inpatient Medicine Associates , LLC

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1982659512
  NPD (past)
• Chattanooga Hamilton County Hospital Authority

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1407034028
  NPD (past)
• University of North Carolina at Chapel Hill

  • Anesthesiology Physician
  • Chapel Hill, NC
  • NPI 1780669200

  Internal Medicine

  NPD (past)

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

• CHI Memorial Hospital - Georgia

  • General Acute Care Hospital
  • Ringgold, GA
  • NPI 1356860621
  Care Compare affiliation
• Phoebe Putney Memorial Hospital Inc

  • General Acute Care Hospital
  • Albany, GA
  • NPI 1992789721
  Care Compare affiliation

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1740220920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 12938",
            "address_2": "C/O CLINIC MANAGEMENT",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "30703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 OLD DALTON ELLIJAY RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307052029",
            "telephone_number": "706-517-2030",
            "fax_number": "706-517-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MITCHELL",
        "middle_name": "JAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "061188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "248099221D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Kelley Leigh Walker, R.PH.
• Waterfall Emergency Physicians, LLC
• Darren Gerald Weeks
• Brandon Wilson, PHARMD

• Internal Medicine Physician in Chatsworth, GA
• Providers in Chatsworth, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.