Active NPI
Olena Vanwonterghem
- Pediatrics Physician
- Newnan, GA
National Provider Identifier
1740692813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 77323
- Practice address
- 15 Baynard Park
Newnan, GA 30265-6413 - Phone
- (770) 251-5253
- NPI assigned
- May 23, 2014
- Last updated
- Jul 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Pediatrics Physician | 208000000X | 77323 | GA | Primary |
Addresses
Primary practice location
15 Baynard Park
Newnan, GA 30265-6413
Mailing address
304 Calgary Dr
Peachtree City, GA 30269-2747
Phone (586) 350-6839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77323 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Services of Central Georgia, Inc | Pediatrics | Past | Accepting new patients |
| Tri-County Pediatrics | Pediatrics | Past | Accepting new patients |
| Primecare Pediatrics, P.C. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Atrium Health Navicent Medical Group
- Multi-Specialty Clinic/Center
- Macon, GA
- NPI 1184679482
Pediatrics
-
- Pediatrics Physician
- Riverdale, GA
- NPI 1285859413
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1740692813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 CALGARY DR",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "302692747",
"telephone_number": "586-350-6839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 BAYNARD PARK",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302656413",
"telephone_number": "770-251-5253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWONTERGHEM",
"first_name": "OLENA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-23",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "77323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.