Provider Demographics
NPI:1669503447
Name:RICHARD E WHEELER MD LLC
Entity Type:Organization
Organization Name:RICHARD E WHEELER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-686-2093
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-0707
Mailing Address - Country:US
Mailing Address - Phone:229-686-2093
Mailing Address - Fax:229-686-7150
Practice Address - Street 1:416A E MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2275
Practice Address - Country:US
Practice Address - Phone:229-686-2093
Practice Address - Fax:229-686-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA95527OtherBLUE CROSS OF GA
GA95527OtherBLUE CROSS OF GA
GAGRP4256Medicare ID - Type Unspecified