Individual provider Active NPI

Jennifer E Wiley, FNP-C

  • Family Nurse Practitioner
  • Demorest, GA
National Provider Identifier
1821660978
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-NP176851 Issued in GA
Practice address
396 Historic Hwy 441 N
Demorest, GA 30535
Phone
(706) 754-4348
NPI assigned
Jul 16, 2021
Last updated
Oct 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN-NP176851 GA Primary

Addresses

Primary practice location

396 Historic Hwy 441 N
Demorest, GA 30535

Mailing address

PO Box 459
Colbert, GA 30628-0459
Phone (706) 788-3234

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803000244 GA Practitioner - Nurse Practitioner 2163325127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medlink Georgia IncGroup PAC ID 3274442850, 93 clinicians

Practice addresses (Care Compare)

396 Historic Hwy 441 N
Demorest, GA 30535-4522
Phone (706) 872-2972

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN-NP176851GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medlink Georgia Inc CurrentSince Jul 6, 2021 Accepting new patients
Medlink Georgia, Inc CurrentSince Jul 6, 2021 Accepting new patients
Medlink Georgia Inc Past Accepting new patients

Locations

11 Charlie Morris Rd
Bldg 2
Colbert, GA 30628
Phone (706) 738-3234

396 441 Historic Hwy N
Demorest, GA 30535
Phone (706) 754-4348

Interoperability endpoints

  • Direct secure messaging: jennifer.wiley.1@9864.direct.athenahealth.com
  • Direct secure messaging: jennifer.wiley@mgi.eclinicaldirectplus.com

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.

Hospital & facility affiliations 1

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": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1821660978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459",
            "telephone_number": "706-788-3234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 HISTORIC HWY 441 N",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "30535",
            "telephone_number": "706-754-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "JENNIFER",
        "middle_name": "E",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-16",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP176851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Demorest, GA

Sources for this page

Verify at the official NPI Registry.