Active NPI
William Shealy
- Physical Therapy Assistant
- Woodstock, GA
National Provider Identifier
1912303264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA002558
- Practice address
- 654 Wedgewood Dr
Woodstock, GA 30189-1505 - Phone
- (573) 429-0563
- Fax
- (770) 926-3256
- NPI assigned
- Nov 14, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA002558 | GA | Primary |
Addresses
Primary practice location
654 Wedgewood Dr
Woodstock, GA 30189-1505
Mailing address
654 Wedgewood Dr
Woodstock, GA 30189-1505
Phone (573) 429-0563
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA002558 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415923200000",
"number": "1912303264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "654 WEDGEWOOD DR",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301891505",
"telephone_number": "573-429-0563",
"fax_number": "770-926-3256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "654 WEDGEWOOD DR",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301891505",
"telephone_number": "573-429-0563",
"fax_number": "770-926-3256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEALY",
"first_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-14",
"last_updated": "2014-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA002558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.