Provider Demographics
NPI:1851447007
Name:HUDAK, WAYNE A
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:HUDAK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WAYNE
Other - Middle Name:A
Other - Last Name:HUDAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5244 WYNTERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3838
Mailing Address - Country:US
Mailing Address - Phone:770-392-9219
Mailing Address - Fax:
Practice Address - Street 1:1360 CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4135
Practice Address - Country:US
Practice Address - Phone:770-343-8550
Practice Address - Fax:770-343-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033988207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033988OtherMEDICAL LICENCE PHYSICIAN