DR. JEFFERY TRAD WADSWORTH (NPI# 1578531216) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578531216 |
| Entity Type | Individual |
| Full Name | DR. JEFFERY TRAD WADSWORTH |
| Credential | MD, FACS |
| Practice Address |
1365a Clifton Rd Ne Room A2303 Atlanta GA 30322-1013 |
| Practice Telephone | 4047783381 |
| Practice Fax Number | 4047784295 |
| Mailing Telephone | 4047783381 |
| Mailing Fax Number | 4047784295 |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2009-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | 0101231639 | VA | Allopathic & Osteopathic Physicians |
| N | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
0101231639 | VA | Allopathic & Osteopathic Physicians |
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
0101231639 | VA | Allopathic & Osteopathic Physicians |
| N | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
0101231639 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | VA PREMIER HEALTH | PAR | 01 |
| VA | CORVEL/CORCARE | PAR | 01 |
| VA | UHC/MAMSI | 294562 | 01 |
| VA | MULTIPLAN | PAR | 01 |
| VA | FIRST HEALTH COMMERCIAL | PAR | 01 |
| VA | CIGNA | PAR | 01 |
| VA | TRICARE/CHAMPUS | -004 | 01 |
| VA | 006503004 | 05 | |
| NC | 89064P3 | 05 | |
| VA | AETNA | PAR | 01 |
| VA | VA HEALTH NETWORK | PAR | 01 |
| VA | USA MANAGED CARE | PAR | 01 |
| VA | SENTARA | 41264 | 01 |
| VA | ANTHEM | 434684 | 01 |
| NC | BC/BS | 064P3 | 01 |
| Street Address |
1365A CLIFTON RD NE ROOM A2303 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30322-1013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477545499 | Micah R Fisher | Internal Medicine | 1365a Clifton Rd Ne, 4th Floor, Atlanta, GA 30322-1013 | 2005-08-16 |
| 1083970743 | Deliane Beloni-bussey | Audiologist | 1365a Clifton Rd Ne, Suite 2300, Atlanta, GA 30322-1013 | 2012-04-06 |
| 1083906960 | George Allen Mayhall | Radiology | 1365a Clifton Rd Ne, Suite At-627, Atlanta, GA 30322-1013 | 2011-05-10 |
| 1821389842 | Timothy Patrick Ryan Jr. | Otolaryngology | 1365a Clifton Rd Ne, Suite 2300, Atlanta, GA 30322-1013 | 2011-04-25 |
| 1588896351 | Jonathan Maclean | Otolaryngology | 1365a Clifton Rd Ne, Atlanta, GA 30322-1013 | 2009-08-12 |
| 1144463738 | Tarek Mohamed Kandeel | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1365a Clifton Rd Ne, Cardiothoracic Surgery Department, Atlanta, GA 30322-1013 | 2009-04-12 |
| 1497904643 | Martha Jean Ryan | Nurse Practitioner | 1365a Clifton Rd Ne, Department of Otolaryngology, Atlanta, GA 30322-1013 | 2008-09-11 |
| 1366627069 | Grace Leu | Otolaryngology | 1365a Clifton Rd Ne, Rm A2316, Atlanta, GA 30322-1013 | 2008-01-01 |
| 1700905932 | Leslie Potter Lawley | Dermatology | 1365a Clifton Rd Ne, Suite 1400, Atlanta, GA 30322-1013 | 2007-03-28 |
| 1235286170 | Bradley Graham Leshnower | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1365a Clifton Rd Ne, Suite 2236, Atlanta, GA 30322-1013 | 2007-01-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445830 | Justin Gill | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne, Clinic B - Suite B6100, Atlanta, GA 30322 | 2019-06-12 |
| 1891354510 | Gwendolyn Gisiner Gunn | Genetic Counselor, MS | Emory Genetics Clinic, 1365 Clifton Road Ne, Atlanta, GA 30322 | 2019-06-06 |
| 1144710567 | Lisa Cathy-ann Akosa | Registered Nurse | 1365 Cifton Road Ne, Atlanta, GA 30322 | 2018-05-10 |
| 1083118004 | Jessica Milian Keilson | Student in an Organized Health Care Education/Training Program | 1364 Clifton Road Ne, Suite H100, Emory University Hospital Office of Surgical Education, Atlanta, GA 30322 | 2018-03-23 |
| 1568982684 | Jennifer Bilko | Dietitian, Registered | 1365 Clifton Rd., Bldg A, 1st Floor, Suite 1450, Atlanta, GA 30322 | 2017-06-20 |
| 1134652258 | Kassahun Bilcha | Student in an Organized Health Care Education/Training Program | 1525 Clifton Rd Ne Ste 100, Atlanta, GA 30322 | 2017-04-05 |
| 1356872246 | Tova Rogers | Dermatology | 1525 Clifton Road Suite 105, Atlanta, GA 30322 | 2017-03-23 |
| 1194271445 | Dina Amin | Dentist | 1365 Clifton,building B, Oral and Maxillofacial Surgery, Suite 2300, Atlanta, GA 30322 | 2016-08-28 |
| 1427404904 | Rita Kaur Kuwahara | Student in an Organized Health Care Education/Training Program | 100 Woodruff Circle, Suite 327, Atlanta, GA 30322 | 2016-05-13 |
| 1891176251 | Octav Cristea | Transplant Surgery | 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322 | 2015-06-11 |
| Find all providers in zip 30322 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033265798 | Aesthetic Solutions Center LLC | Otolaryngology | 5730 Glenridge Dr Ste T200, Sandy Springs, GA 30328-5873 | 2007-01-26 |
| 1639795529 | Savannah Stockton | Otolaryngology | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-17 |
| 1689084022 | Marc Polacco | Otolaryngology | 902 Ponder Place Ct, Evans, GA 30809-3115 | 2014-05-07 |
| 1447698964 | Georgia Northside Ear, Nose and Throat, LLC | Otolaryngology | 1360 Upper Hembree Rd, Suite 201, Roswell, GA 30076-1171 | 2013-06-06 |
| 1649468463 | Joseph H. Berger, Md, LLC | Otolaryngology | 305 W Hansell St, Thomasville, GA 31792-6649 | 2007-10-05 |
| 1366553349 | Brian J Szwarc | Otolaryngology | 100 Mimosa Dr, 3rd Floor, Thomasville, GA 31792-6676 | 2006-08-31 |
| 1538276332 | Fred Mcconnel | Otolaryngology | 1670 Clairmont Rd, Surgical Service 112, Decatur, GA 30033-4004 | 2006-08-25 |
| 1629086327 | Ear, Nose, Throat, and Allergy Associates of South Georgia | Otolaryngology | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2006-08-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.