Provider Demographics
NPI:1205824323
Name:WAHBEH, ANTHONY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:WAHBEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 RIVERSTONE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2888
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-4683
Practice Address - Street 1:1558 RIVERSTONE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2888
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-4683
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52680724002OtherBCBS
GA000805175CMedicaid