MEDICARE: RICHARD E WHEELER MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	046277	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95527	OTHER	GA	BLUE CROSS OF GA

General Provider Information

NPI Number	:	1669503447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD E WHEELER MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 707
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-0707
Country	:	US
Telephone Number	:	229-686-2093
Fax Number	:	229-686-7150

Provider Business Practice Location Address
First Line	:	416A E MCPHERSON AVE
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-2275
Country	:	US
Telephone Number	:	229-686-2093
Fax Number	:	229-686-7150

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD E WHEELER
Credential	:	M.D.
Telephone Number	:	229-686-2093

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/16/2008

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Directions to “RICHARD E WHEELER MD LLC ” Practice Location

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