Active NPI
Edward Dale Wysong, M.D.
- Family Medicine Physician
- Hartwell, GA
National Provider Identifier
1841213790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 015443
- Practice address
- 229 Athens St
Hartwell, GA 30643-1854 - Phone
- (706) 376-3957
- Fax
- (706) 376-1356
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 015443 | GA | Primary |
Addresses
Primary practice location
229 Athens St
Hartwell, GA 30643-1854
Mailing address
229 Athens St
Hartwell, GA 30643-1854
Phone (706) 376-3957
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000090703A | Medicaid | GA | |
| 024242 | Other | GA | BLUE CROSS |
| CB5824 | Other | GA | RAILROAD MEDICARE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1841213790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 ATHENS ST",
"city": "HARTWELL",
"state": "GA",
"postal_code": "306431854",
"telephone_number": "706-376-3957",
"fax_number": "706-376-1356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 ATHENS ST",
"city": "HARTWELL",
"state": "GA",
"postal_code": "306431854",
"telephone_number": "706-376-3957",
"fax_number": "706-376-1356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYSONG",
"first_name": "EDWARD",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "015443",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000090703A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "024242",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CB5824",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartwell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.