Provider Demographics
NPI:1457495103
Name:WASDEN, HOWELL ANDERSON III
Entity Type:Individual
Prefix:
First Name:HOWELL
Middle Name:ANDERSON
Last Name:WASDEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:5919 SPRING STREET
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-0447
Mailing Address - Country:US
Mailing Address - Phone:706-655-3591
Mailing Address - Fax:
Practice Address - Street 1:5919 SPRING STREET
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-0447
Practice Address - Country:US
Practice Address - Phone:706-655-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMD17338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
O31239Medicare UPIN