Daren C Wannamaker, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

55037 Issued in GA

Practice address

4285 Jim Moore Rd Ste 200
Dacula, GA 30019-1551

Phone

(770) 442-1911

Fax

(770) 442-0306

NPI assigned

Aug 31, 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 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

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.

• Southeast Medical Group, P.C.

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1235296054
  Medicare reassignment NPD
• Capital Healthcare PC

  • Primary Care Clinic/Center
  • Alexandria, VA
  • NPI 1811239627

  GA, Internal Medicine

  Medicare reassignment NPD
• Alex E. Rikhter, MD P.C.

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1871939751
  NPD
• Allcare Ga PC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1972080554
  NPD
• University Primary Care

  • Internal Medicine Physician
  • Augusta, GA
  • NPI 1124231808
  NPD
• Physician First Health Network

  • Public Health or Welfare Agency
  • Alpharetta, GA
  • NPI 1598558181
  NPD (past)
• Heal Doctors Ihwa, P.C.

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1447917125
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1780795708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 PEACHTREE ST NE",
            "address_2": "STE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303086009",
            "telephone_number": "443-363-3953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4285 JIM MOORE RD STE 200",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191551",
            "telephone_number": "770-442-1911",
            "fax_number": "770-442-0306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4321 University Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Evans",
            "state": "GA",
            "postal_code": "308093093",
            "country_code": "US",
            "telephone_number": "706-685-4218",
            "fax_number": "706-854-2189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "570 Briscoe Blvd",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300464637",
            "country_code": "US",
            "telephone_number": "877-757-9964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANNAMAKER",
        "first_name": "DAREN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "55037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003775SC",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25465600FL",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alina Lavinia Vlasin-Morariu
• Walgreen Co
• Walgreen Co
• Jocilli Walton
• Alyssa Walz
• Mary Carly Warbington, OTR/L
• Jeremy Robert Ward, DMD
• Andrea Rose Watson, PTA
• Natanyah Watson, M.B.A. HM, B.S. MLS
• Lori Darnelle Weeks, NP

• Internal Medicine Physician in Dacula, GA
• Providers in Dacula, 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 May 10, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.