NPIMap

Individual provider Active NPI

Wilburn Edwin George Jr., MD

  • Cardiovascular Disease Physician
  • Tullahoma, TN
National Provider Identifier
1902862519
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD10360 Issued in TN
Practice address
1801 North Jackson Street
Tullahoma, TN 37388
Phone
(931) 393-7831
Fax
(931) 393-7833
NPI assigned
Apr 22, 2006
Last updated
Jan 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD10360 TN Primary

Addresses

Primary practice location

1801 North Jackson Street
Tullahoma, TN 37388

Mailing address

PO Box 938
Tullahoma, TN 37388
Phone (931) 393-7831

Other identifiers 2

IdentifierTypeStateIssuer
58479OtherTNBLUECROSS
3014316MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050826000884 TN Practitioner - Cardiovascular Disease (Cardiology) 5890682553 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Tennessee, HSC, College of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Thomas Medical PartnersGroup PAC ID 1557269354, 588 clinicians

Practice addresses (Care Compare)

791 Old Hickory Blvd
Brentwood, TN 37027-4504
Phone (629) 888-5125

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD10360TNMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coffee Medical Group LLC CurrentSince Dec 1, 2012 Accepting new patients
Coffee Medical Group LLC CurrentSince Dec 1, 2012 Accepting new patients
Cardiology Group, PC Cardiovascular Disease PastSince Feb 28, 2004 Accepting new patients

Locations

1001 McArthur St
Manchester, TN 37355
Phone (931) 728-3586

481 Interstate Dr
Manchester, TN 37355
Phone (931) 728-3586

1801 N Jackson St
Tullahoma, TN 37388
Phone (931) 393-3000

Organizations & group practices 4

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 6

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": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1902862519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 938",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "37388",
            "telephone_number": "931-393-7831",
            "fax_number": "931-393-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NORTH JACKSON STREET",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "37388",
            "telephone_number": "931-393-7831",
            "fax_number": "931-393-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "WILBURN",
        "middle_name": "EDWIN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-22",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "MD10360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "58479",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3014316",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.