Provider Demographics
NPI:1285728741
Name:PRICE, WENDELL F JR (NPC)
Entity type:Individual
Prefix:
First Name:WENDELL
Middle Name:F
Last Name:PRICE
Suffix:JR
Gender:M
Credentials:NPC
Other - Prefix:
Other - First Name:DEL
Other - Middle Name:F
Other - Last Name:PRICE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:NPC
Mailing Address - Street 1:209 ELVAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1354
Mailing Address - Country:US
Mailing Address - Phone:404-388-4903
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:STE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:404-388-4903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN071462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP27780Medicare UPIN