Individual provider Active NPI

Mahlet Waregay, FNP

  • Nurse Practitioner
  • Woodstock, GA
National Provider Identifier
1871342089
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN242296 Issued in GA
Practice address
1600 Towne Lake Pkwy
Woodstock, GA 30189-1585
Phone
(770) 517-1022
NPI assigned
May 20, 2024
Last updated
May 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN242296 GA Primary

Addresses

Primary practice location

1600 Towne Lake Pkwy
Woodstock, GA 30189-1585

Mailing address

1600 Towne Lake Pkwy
Woodstock, GA 30189-1585
Phone (770) 517-1022

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
I20240729002794 GA Practitioner - Nurse Practitioner 7416493283 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic LLC Nurse Practitioner CurrentSince Jun 20, 2024 Accepting new patients
Primary Care PLLC CurrentSince Sep 10, 2024 Accepting new patients

Locations

11710 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 754-0141

1600 Towne Lake Pkwy
Woodstock, GA 30189
Phone (678) 736-9549

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1871342089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 TOWNE LAKE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301891585",
            "telephone_number": "770-517-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 TOWNE LAKE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301891585",
            "telephone_number": "770-517-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAREGAY",
        "first_name": "MAHLET",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN242296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

Verify at the official NPI Registry.