Basic Information
| Provider Information | |||||||||
| NPI: | 1578531216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADSWORTH | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | TRAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365A CLIFTON RD NE | ||||||||
| Address2: | ROOM A2303 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783381 | ||||||||
| FaxNumber: | 4047784295 | ||||||||
| Practice Location | |||||||||
| Address1: | 1365A CLIFTON RD NE | ||||||||
| Address2: | ROOM A2303 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783381 | ||||||||
| FaxNumber: | 4047784295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | 0101231639 | VA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207Y00000X | 0101231639 | VA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0901X | 0101231639 | VA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | 207YP0228X | 0101231639 | VA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 006503004 | 05 | VA | MEDICAID | 89064P3 | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 294562 | 01 | VA | UHC/MAMSI | OTHER | 434684 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | 064P3 | 01 | NC | BC/BS | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | -004 | 01 | VA | TRICARE/CHAMPUS | OTHER | 41264 | 01 | VA | SENTARA | OTHER | PAR | 01 | VA | AETNA | OTHER |