MEDICARE: ATRIUM FAMILY MEDICAL CLINIC

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	207Q00000X	Family Medicine Physician	D7800	TX

General Provider Information

NPI Number	:	1518159573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATRIUM FAMILY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	14465 WEBB CHAPEL RD STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-3600
Country	:	US
Telephone Number	:	972-247-6900
Fax Number	:	972-247-6923

Provider Business Practice Location Address
First Line	:	14465 WEBB CHAPEL RD STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-3600
Country	:	US
Telephone Number	:	972-247-6900
Fax Number	:	972-247-6923

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS HOWARD WADDELL
Credential	:	MD
Telephone Number	:	972-247-6900

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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Directions to “ATRIUM FAMILY MEDICAL CLINIC ” Practice Location

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