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1881695104

NPI Code Detail

MEDICARE: DR. GEORGIA L WIESNER MD

MEDICARE: DR. GEORGIA L WIESNER 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	207SG0201X	Clinical Genetics (M.D.) Physician	35067621	OH
2	207SG0201X	Clinical Genetics (M.D.) Physician	MD48589	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000529595	OTHER	OH	ANTHEM
2	4614845	OTHER	OH	AETNA
3	0995393	OTHER	OH	BCMH
4	364132	OTHER	OH	WELLCARE
5	745997	OTHER	OH	BUCKEYE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	000000224342	OTHER	OH	UNISON

General Provider Information

NPI Number	:	1881695104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGIA L WIESNER MD

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-5100
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/17/2022

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Directions to “ DR. GEORGIA L WIESNER MD” Practice Location

Language	Start Address	Practice Location

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