Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN168858 | GA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN168858 | GA |
NPI | 1023151909 |
---|---|
Provider Name | Mr. Andrew Michael Wheeler |
First Address | Macon, GA 31201-6840 |
Second Address | Macon, GA 31201-6840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 01/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235778149A | (05) | GA |