Deena Renae Wise, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

86763 Issued in GA

Practice address

1514 Vernon Rd
Lagrange, GA 30240-4131

Phone

(770) 845-3132

NPI assigned

Jan 12, 2006

Last updated

Apr 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Deena Renae Walden Other name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in FL, SC, NC, GA, KY, NM6 enrollments

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 6

Specialty

Pediatric Medicine

Education

Oklahoma State University College of Osteopathic Medicine, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: deena.wise.1@16436.direct.athenahealth.com
• Direct secure messaging: dwise1093920@direct.unc.nchie.net
• Direct secure messaging: dwise27909@directmcleodehealth.org
• Direct secure messaging: dwise3043295@carolinashealthcaresystem.direct-ci.com
• Direct secure messaging: dwise731640@direct.unitypoint.org

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.

• Cogent Healthcare of Georgia PC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1609827823

  Hospitalist

  Medicare reassignment NPD
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385

  NC

  Medicare reassignment NPD
• Baptist Physician Associates LLC

  • Urgent Care Clinic/Center
  • Navarre, FL
  • NPI 1235128646

  Pediatrics

  Medicare reassignment NPD
• Beaufort County Memorial Hospital

  • Internal Medicine Physician
  • Beaufort, SC
  • NPI 1598713117
  Medicare reassignment NPD
• DLP Western Carolina Physician Practices LLC

  • Internal Medicine Physician
  • Sylva, NC
  • NPI 1609281641

  Pediatrics

  Medicare reassignment NPD
• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  Hospitalist, NC

  Medicare reassignment NPD
• Florida Hospital Medical Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Pediatrics

  Medicare reassignment NPD
• Hospital Physician Services of Florida PA

  • Hospitalist Physician
  • Pensacola, FL
  • NPI 1558718635
  Medicare reassignment NPD
• McLeod Health Clarendon

  • Certified Registered Nurse Anesthetist
  • Manning, SC
  • NPI 1508218793
  Medicare reassignment NPD
• North Okaloosa Clinic Corp

  • Internal Medicine Physician
  • Crestview, FL
  • NPI 1659329852

  Pediatrics

  Medicare reassignment NPD
• Owensboro Health Medical Group Inc

  dba Owensboro Health Muhlenberg Community Hospital Wound Center

  • Surgery Physician
  • Greenville, KY
  • NPI 1235518242
  Medicare reassignment NPD
• Scotland Memorial Hospital Inc

  dba SURGICAL ASSOCIATES of SCOTLAND

  • Vascular Surgery Physician
  • Laurinburg, NC
  • NPI 1477791507
  Medicare reassignment NPD

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1982683488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 WREN WAY",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325787102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "770-845-3132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2502 W Elk Ave",
            "address_purpose": "LOCATION",
            "city": "Duncan",
            "state": "OK",
            "postal_code": "735331562",
            "country_code": "US",
            "telephone_number": "580-252-9600",
            "fax_number": "580-252-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4200 Sun N Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Sebring",
            "state": "FL",
            "postal_code": "338721986",
            "country_code": "US",
            "telephone_number": "407-975-0412",
            "fax_number": "407-975-0407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "850 S Main St",
            "address_purpose": "LOCATION",
            "city": "Holly Springs",
            "state": "NC",
            "postal_code": "275408906",
            "country_code": "US",
            "telephone_number": "984-960-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Park St",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421011760",
            "country_code": "US",
            "telephone_number": "270-796-6540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "DEENA",
        "middle_name": "RENAE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-12",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2002008852",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS15511",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "3820",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "05305",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2020-03433",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "86763",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "OS15511",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100877500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwise1093920@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "850 S Main St",
            "city": "Holly Springs",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275408906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwise584287@directwellstar.org",
            "affiliation": "N",
            "address_1": "1514 Vernon Rd",
            "city": "LaGrange",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302404131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEENA",
            "last_name": "WALDEN",
            "middle_name": "RENAE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eddie Q Willis, DMD
• Linda Willoughby, RPH.
• Kenleeanne Hass Wilson, DMD
• Robin Wilson, LPN
• Joni Lee Winter, FNP
• Wolf Specific, Inc (The Upper Cervical Center)
• Matthew Tyler Wolfertz, D.C.
• Candace H Wortham, CFNP
• Chiquita Yvette Wright
• James L Yancey

• Pediatrics Physician in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.