Provider Demographics
NPI:1760460554
Name:LENZ, WENDY HAWKE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:HAWKE
Last Name:LENZ
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 1:224 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1811
Mailing Address - Country:US
Mailing Address - Phone:770-883-1581
Mailing Address - Fax:
Practice Address - Street 1:224 SENECA ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1811
Practice Address - Country:US
Practice Address - Phone:770-883-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27563207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000308536CMedicaid
GA000308536CMedicaid
GA83BBBKTMedicare PIN