MEDICARE: BRUCE H. WAINER M.D., PH.D.

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	207ZP0101X	Anatomic Pathology Physician	041025	GA

General Provider Information

NPI Number	:	1548218605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE H. WAINER M.D., PH.D.

Provider Business Mailing Address
First Line	:	1841 CLIFTON RD NE
Second Line	:	ROOM 208
City	:	ATLANTA
State	:	GA
Zip	:	30329-4021
Country	:	US
Telephone Number	:	404-728-4888
Fax Number	:	404-728-4917

Provider Business Practice Location Address
First Line	:	1841 CLIFTON RD NE
Second Line	:	ROOM 208
City	:	ATLANTA
State	:	GA
Zip	:	30329-4021
Country	:	US
Telephone Number	:	404-728-4888
Fax Number	:	404-728-4917

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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