Provider Demographics
NPI:1255463873
Name:WACHTEL, DANIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WACHTEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 JOHNSON FERRY RD STE 140-172
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1435
Mailing Address - Country:US
Mailing Address - Phone:404-723-5633
Mailing Address - Fax:
Practice Address - Street 1:5605 GLENRIDGE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1365
Practice Address - Country:US
Practice Address - Phone:404-723-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGVXMedicare Oscar/Certification