Healthcare Provider Details

I. General information

NPI: 1730962507
Provider Name (Legal Business Name): JOSHUA MARK WENDLING NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 IRVIN CT STE 200
DECATUR GA
30030-1780
US

IV. Provider business mailing address

1559 BRAEBURN DR SE
ATLANTA GA
30316-2127
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-1335
  • Fax: 404-299-7499
Mailing address:
  • Phone: 770-713-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN284503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: