DR. CHENEY FENN WILSON (NPI# 1477972982) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1477972982 |
Entity Type | Individual |
Full Name | DR. CHENEY FENN WILSON |
Credential | M.D. |
Practice Address |
460 Northside Cherokee Blvd Ste 100 Canton GA 30115-8017 |
Mailing Address |
4301 W Markham St Little Rock AR 72205-7101 |
Practice Telephone | 7702923490 |
Practice Fax Number | 7707215615 |
Mailing Telephone | 5016866627 |
Enumeration Date | 2014-04-11 |
Last Update Date | 2019-06-09 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
82615 | GA | Allopathic & Osteopathic Physicians |
N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
Street Address |
460 NORTHSIDE CHEROKEE BLVD STE 100 |
City | CANTON |
State | GA |
Zip Code | 30115-8017 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134188105 | Eddy Toussaint | Physician Assistant | 460 Northside Cherokee Blvd Ste 100, Canton, GA 30115-8017 | 2006-03-20 |
1003388679 | Holly Allen | Nurse Practitioner | 460 Northside Cherokee Blvd Ste 100, Canton, GA 30115-8017 | 2018-12-20 |
1154504082 | Edward Park Kang | Surgery | 460 Northside Cherokee Blvd Ste 100, Canton, GA 30115-8017 | 2007-12-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497364806 | Amanda Arbogast | Speech-Language Pathologist | 610 Royal Crest Court, Canton, GA 30115 | 2020-07-31 |
1033754163 | Kelly Marie Shirley | Nurse Practitioner | 450 Northside Cherokee Blvd., Radiology Dept., Canton, GA 30115 | 2019-11-13 |
1700394319 | Jennifer Lynn Davenport | Nurse Practitioner | 684 Sixes Rd Ste 125, Holly Springs, GA 30115 | 2018-01-17 |
1851717961 | Wal-mart Stores East, Lp | Technician/Technologist | 2200 Holly Springs Pkey, Holly Springs, GA 30115 | 2014-03-13 |
1194148502 | Julia Bedingfield Reid | Pharmacist | 450 Northside Cherokee Blvd Ste T20, Canton, GA 30115 | 2014-01-22 |
1447597992 | America's Best Contacts & Eyeglasses | Technician/Technologist | 2030 Cumming Highway, Suite 106, Canton, GA 30115 | 2013-01-03 |
1679821193 | Jill M Decorso | Speech-Language Pathologist | 4280 Hickory Flat Hwy, Ste 108, Canton, GA 30115 | 2012-08-15 |
1306113378 | Sidney Boyd Collier IIi | Pharmacist | 6111 Hickory Flat Highway, Canton, GA 30115 | 2011-11-18 |
1174804702 | Rayllensons Itacy | Physician Assistant | 2020 Cumming Highway, Suite 102, Canton, GA 30115 | 2011-09-09 |
1245534346 | Kim M. Mcmillan | Counselor | 154 Lakeside Drive, Canton, GA 30115 | 2011-01-04 |
Find all providers in zip 30115 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760417893 | Neponset Valley Surgical PC | Surgery | 800 Washington Street, Canton, MA 02021-2562 | 2006-07-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285241265 | Jennifer Ann Hales | Surgery | 11090 Mcauley, Suite 100 2a, Savannah, GA 31419 | 2020-09-24 |
1902423387 | Center for Vein Restoration Ga Corp | Surgery | 1100 Johnson Fy Rd Ne Ste 165, Atlanta, GA 30342-1795 | 2020-07-01 |
1487133278 | Usa Vascular Center of Decatur LLC | Surgery | 495 Winn Way Ste 230, Decatur, GA 30030-1736 | 2018-08-13 |
1841789914 | Milner Vein and Vascular LLC | Surgery | 5700 Hillandale Dr Ste 150, Lithonia, GA 30058 | 2018-05-04 |
1023517505 | Antioch Vascular Center, LLC | Surgery | 9104 Middleground Road, Suite 2, Savannah, GA 31406 | 2018-02-09 |
1689012205 | Daniel Joseph Badia | Surgery | 601 Professional Dr Ste A220, Lawrenceville, GA 30046-7698 | 2013-06-05 |
1740507425 | Christopher Ray Ramos | Surgery | 1365 Clifton Road Ne, Building A, Room A2200, Atlanta, GA 30322 | 2010-04-21 |
1184879678 | Rockdale Vascular and Thoracic Surgery, LLC | Surgery | 1368c Wellbrook Cir Ne, Conyers, GA 30012-3872 | 2008-11-25 |
1528218393 | Vladimir Zahradnik | Surgery | 380 Hospital Dr Bldg A Ste 320, Macon, GA 31217 | 2008-09-29 |
1487819132 | Yazan Duwayri | Surgery | Division of Vascular Surgery Emory Clinic Bldg A, 1365 Clifton Road Ne. 3rd Floor, Atlanta, GA 30322-0001 | 2008-07-22 |
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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.