MEDICARE: JOSEPH WANDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC008701	GA

General Provider Information

NPI Number	:	1184098055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WANDERS

Provider Business Mailing Address
First Line	:	126 ENTERPRISE PATH STE 201
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2654
Country	:	US
Telephone Number	:	678-567-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 201
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2654
Country	:	US
Telephone Number	:	678-567-0920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	06/14/2016

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Directions to “ JOSEPH WANDERS ” Practice Location

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