Healthcare Provider Details

I. General information

NPI: 1124207261
Provider Name (Legal Business Name): GREGORY L. WEHUNT, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MERCHANTS SQ STE C
DALLAS GA
30132-0930
US

IV. Provider business mailing address

290 MERCHANTS SQ STE C
DALLAS GA
30132-0930
US

V. Phone/Fax

Practice location:
  • Phone: 770-443-3335
  • Fax: 770-443-3394
Mailing address:
  • Phone: 770-443-3335
  • Fax: 770-443-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025847
License Number StateGA

VIII. Authorized Official

Name: DR. GREGORY LAWRENCE WEHUNT
Title or Position: OWNER/DOCTOR
Credential: D.O.
Phone: 770-443-3335