Adam Waksor, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN014234 Issued in GA

Practice address

1040 Eagle Lndng Pkwy
Stockbridge, GA 30281-9072

Phone

(917) 922-2750

Fax

(678) 289-8560

NPI assigned

Aug 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1831199843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819072",
            "telephone_number": "678-836-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EAGLE LNDNG PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819072",
            "telephone_number": "917-922-2750",
            "fax_number": "678-289-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKSOR",
        "first_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "047013-1",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN014234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02348781",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vitalroute Medical Transport
• Tobias Nikolaus Von Bergen, M.D.
• VRM Nursging LLC
• Hung Phu Vuong
• Sasha Hyatt Wahab, MD, MA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0745)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3402)
• Wal-Mart Stores East, LP (Vision Center 30-3402)
• Wal-Mart Stores East, LP.
• Walgreen Co (Rite Aid #11784)

• Oral and Maxillofacial Surgery (Dentist) in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.