Provider Demographics
NPI:1689604894
Name:WOBECK, LINDA KELLER (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KELLER
Last Name:WOBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:DEPT OF RADIATION ONCOLOGY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-3426
Mailing Address - Fax:770-916-4434
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-3426
Practice Address - Fax:770-916-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA396282085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00937076AMedicaid
GAG98440Medicare UPIN
GA92BDDJTMedicare PIN