Provider Demographics
NPI:1467415257
Name:WENDELL O HACKNEY MD & GREGORY A SMITH PC
Entity Type:Organization
Organization Name:WENDELL O HACKNEY MD & GREGORY A SMITH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:HACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-522-4888
Mailing Address - Street 1:315 BLVD NE
Mailing Address - Street 2:STE 336
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-522-4888
Mailing Address - Fax:404-581-0379
Practice Address - Street 1:315 BLVD NE
Practice Address - Street 2:STE 336
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-522-4888
Practice Address - Fax:404-581-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1059Medicare ID - Type Unspecified