Healthcare Provider Details

I. General information

NPI: 1578688941
Provider Name (Legal Business Name): JEFFREY WAINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 ATLANTA AVE
HAPEVILLE GA
30354-1706
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST TOWER
ADDISON TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-3351
  • Fax:
Mailing address:
  • Phone: 800-232-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number040582
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: