Individual provider Active NPI

Ebony B Whisenant, M.D.

  • Family Medicine Physician
  • Augusta, GA
National Provider Identifier
1891957353
Registry record updated Nov 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83947 Issued in GA
Practice address
Augusta University Medical Ctr 1120 15TH Street
Augusta, GA 30912-2516
Phone
(706) 721-8623
Fax
(706) 721-1459
NPI assigned
Jun 26, 2008
Last updated
Nov 1, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME106882 FL
Family Medicine Physician 207Q00000X TRN12292 FL
Family Medicine Physician 207Q00000X 83947 GA Primary

Addresses

Primary practice location

Augusta University Medical Ctr 1120 15TH Street
Augusta, GA 30912-2516

Mailing address

1120 15TH St Ste Bi1056
Augusta, GA 30912-0004
Phone (706) 721-3813

Other practice location 1

Augusta University Medical Ctr 1120 15th Street
Augusta, GA 30912-2516
Phone (706) 721-8623

Other identifiers 1

IdentifierTypeStateIssuer
83947OtherGAGEORGIA MEDICAL LICENSE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191214000550 GA Practitioner - Family Practice 2466622790 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Morehouse School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beulah Grove Community Resource CenterGroup PAC ID 3779471743, 4 clinicians

Practice addresses (Care Compare)

1448 Lee Beard Way
Augusta, GA 30901-3414
Phone (706) 828-7468

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN12292FLMDFamily Medicine Physician
83947GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Au Medical Associates Inc CurrentSince Dec 1, 2019 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2023 Accepting new patients
Beulah Grove Community Resource Center CurrentSince Sep 15, 2024 Accepting new patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
Au Medical Associates Inc CurrentSince Dec 1, 2019 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2023 Accepting new patients
Tenet-Solantic Joint Venture LLC PastSince Nov 22, 2010 Accepting new patients
Bethesda/Solantic Joint Venture, LLC PastSince Jul 2, 2009 Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1120 15th St
Ste BI1056
Augusta, GA 30912
Phone (706) 721-2785

1448 Linden St
Augusta, GA 30901
Phone (706) 828-3775

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Interoperability endpoints

  • Direct secure messaging: ebony.whisenant.1@31857.direct.athenahealth.com

Organizations & group practices 8

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": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1891957353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 15TH ST STE BI1056",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-3813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AUGUSTA UNIVERSITY MEDICAL CTR 1120 15TH STREET",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309122516",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Augusta University Medical Ctr 1120 15th Street",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309122516",
            "country_code": "US",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHISENANT",
        "first_name": "EBONY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME106882",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN12292",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "83947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA MEDICAL LICENSE",
            "identifier": "83947",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.