Active NPI
Gina D Wise
- Optician
- Fayetteville, GA
National Provider Identifier
1932416617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- LDO000890
- Practice address
- 101 Yorktown Dr
Suite 225
Fayetteville, GA 30214-1568 - Phone
- (770) 460-2331
- Fax
- (770) 460-2099
- NPI assigned
- Sep 2, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | LDO000890 | GA | Primary |
Addresses
Primary practice location
101 Yorktown Dr
Suite 225
Fayetteville, GA 30214-1568
Mailing address
101 Yorktown Dr
Suite 225
Fayetteville, GA 30214-1568
Phone (770) 460-2331
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 |
|---|---|---|---|
| LDO000890 | GA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1932416617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 YORKTOWN DR",
"address_2": "SUITE 225",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302141568",
"telephone_number": "770-460-2331",
"fax_number": "770-460-2099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 YORKTOWN DR",
"address_2": "SUITE 225",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302141568",
"telephone_number": "770-460-2331",
"fax_number": "770-460-2099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "GINA",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-02",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "GA",
"license": "LDO000890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.