Provider Demographics
NPI:1588684278
Name:WHEELER, GEORGE A (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1561
Mailing Address - Country:US
Mailing Address - Phone:912-284-9800
Mailing Address - Fax:912-284-1711
Practice Address - Street 1:1218 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4525
Practice Address - Country:US
Practice Address - Phone:912-284-9800
Practice Address - Fax:912-284-1711
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00503214AMedicaid
GAF29808Medicare UPIN
GA00503214AMedicaid