Provider Demographics
NPI:1548218605
Name:WAINER, BRUCE H (MD, PHD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:WAINER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 CLIFTON RD NE
Mailing Address - Street 2:ROOM 208
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4021
Mailing Address - Country:US
Mailing Address - Phone:404-728-4888
Mailing Address - Fax:404-728-4917
Practice Address - Street 1:1841 CLIFTON RD NE
Practice Address - Street 2:ROOM 208
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4021
Practice Address - Country:US
Practice Address - Phone:404-728-4888
Practice Address - Fax:404-728-4917
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041025207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE72913Medicare UPIN