Provider Demographics
NPI:1578598371
Name:WEHUNT, GREGORY LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAWRENCE
Last Name:WEHUNT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:290 MERCHANTS SQ STE C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0930
Mailing Address - Country:US
Mailing Address - Phone:770-443-3335
Mailing Address - Fax:770-443-3394
Practice Address - Street 1:290 MERCHANTS SQ STE C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0930
Practice Address - Country:US
Practice Address - Phone:770-443-3335
Practice Address - Fax:770-443-3394
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA025847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBTJDMedicare PIN
GAD31268Medicare UPIN