MEDICARE: RICHARD E WHEELER MD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619954112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E WHEELER MD

Provider Business Mailing Address
First Line	:	907 18TH ST E STE 400
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-3684
Country	:	US
Telephone Number	:	229-353-3450
Fax Number	:	229-353-6060

Provider Business Practice Location Address
First Line	:	416 E MCPHERSON AVE STE A
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-2277
Country	:	US
Telephone Number	:	229-686-2093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	03/08/2021

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Directions to “ RICHARD E WHEELER MD” Practice Location

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