Provider Demographics
NPI:1124207261
Name:GREGORY L. WEHUNT, D.O.
Entity Type:Organization
Organization Name:GREGORY L. WEHUNT, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WEHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-443-3335
Mailing Address - Street 1:290 MERCHANTS SQ STE C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0930
Mailing Address - Country:US
Mailing Address - Phone:770-443-3335
Mailing Address - Fax:770-443-3394
Practice Address - Street 1:290 MERCHANTS SQ STE C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0930
Practice Address - Country:US
Practice Address - Phone:770-443-3335
Practice Address - Fax:770-443-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00275371GMedicaid
GA00275371GMedicaid
GAD31268Medicare UPIN