Provider Demographics
NPI:1285919845
Name:WENIGER, BRUCE GILBERT (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GILBERT
Last Name:WENIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 CRESTLINE CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3814
Mailing Address - Country:US
Mailing Address - Phone:404-634-1089
Mailing Address - Fax:
Practice Address - Street 1:1737 CRESTLINE CT NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3814
Practice Address - Country:US
Practice Address - Phone:404-634-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164856-12052083P0901X
CAGFE471722083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine