Basic Information
| Provider Information | |||||||||
| NPI: | 1881884260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHL | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | MCADAMS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16389 | ||||||||
| Address2: | FGH TRAUMA SURGERY CLINIC | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394046389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012882690 | ||||||||
| FaxNumber: | 6012882695 | ||||||||
| Practice Location | |||||||||
| Address1: | 6059 HWY 49 S | ||||||||
| Address2: | FORREST GENERAL HOSPITAL | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394046389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012882890 | ||||||||
| FaxNumber: | 6012882695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD200367 | LA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1070891 | 05 | LA | MEDICAID | BW9589447 | 01 | DEA | OTHER | 33047 | 01 | LA | CDS | OTHER |