Provider Demographics
NPI:1124104377
Name:WENER, FREDERICK P (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:P
Last Name:WENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3969 SOUTH COBB DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-436-0041
Mailing Address - Fax:770-436-0335
Practice Address - Street 1:3969 SOUTH COBB DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-436-0041
Practice Address - Fax:770-436-0335
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA27688207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00325025AMedicaid
0004049022OtherAETNA
GA52159038OtherBLUE CROSS
GA00325025AMedicaid