Healthcare Provider Details

I. General information

NPI: 1780604058
Provider Name (Legal Business Name): WAYNE WARE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

IV. Provider business mailing address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

V. Phone/Fax

Practice location:
  • Phone: 866-327-2166
  • Fax: 404-350-7381
Mailing address:
  • Phone: 866-327-2166
  • Fax: 404-350-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC000923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: