Provider Demographics
NPI:1306259031
Name:STUDENIC, GARY
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:STUDENIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BILL MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5351
Mailing Address - Country:US
Mailing Address - Phone:404-784-7722
Mailing Address - Fax:770-971-5554
Practice Address - Street 1:1395 S MARIETTA PKWY SE STE 102
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7852
Practice Address - Country:US
Practice Address - Phone:770-425-8700
Practice Address - Fax:770-425-8740
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist