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General NPI Number Information
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NPI Number | 1073678066
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Entity Type | Individual
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Provider Name | GARY MARC WETHERINGTON MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 506 RIVERSIDE PKWY NE SUITE 200
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City | ROME
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State | GA
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Zip | 30161-2902
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Country | US
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Telephone | 706-291-4334
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Fax | 706-291-0248
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Provider Business Mailing Address
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Address Line | PO BOX 468
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City | ROME
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State | GA
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Zip | 30162-0468
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Country | US
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Telephone | 706-291-4334
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Fax | 706-291-0248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 030690
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License Number State | GA
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