MEDICARE: LYNDON D WAUGH 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	2084P0800X	Psychiatry Physician	017657	GA

General Provider Information

NPI Number	:	1992750350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDON D WAUGH MD

Provider Business Mailing Address
First Line	:	7000 PEACHTREE DUNWOODY RD
Second Line	:	BLDG 16 SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

Provider Business Practice Location Address
First Line	:	7000 PEACHTREE DUNWOODY RD
Second Line	:	BLDG 16 SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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