Provider Demographics
NPI:1598935884
Name:ROSS, WAYNE CHARLES (DO,)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:CHARLES
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 PIEDMONT AVE NE
Mailing Address - Street 2:SUITE H
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5000
Mailing Address - Country:US
Mailing Address - Phone:404-316-1340
Mailing Address - Fax:
Practice Address - Street 1:1529 PIEDMONT AVE NE
Practice Address - Street 2:SUITE H
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5000
Practice Address - Country:US
Practice Address - Phone:404-316-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA445752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry