Provider Demographics
NPI:1164490678
Name:WACHS, JOEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:WACHS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA54136207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA423844937FMedicaid
D94950Medicare UPIN
GA20206I0584Medicare PIN
GA423844937KMedicaid
GA423844937JMedicaid
D94950Medicare UPIN
GA423844937IMedicaid
GA423844937GMedicaid