Provider Demographics
NPI:1396997235
Name:BUCHHEIT, WANDA G (PA-C)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:G
Last Name:BUCHHEIT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:G
Other - Last Name:BUCHHEIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2863
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-6511
Mailing Address - Country:US
Mailing Address - Phone:770-888-0448
Mailing Address - Fax:
Practice Address - Street 1:6825 TURNING LEAF CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-4773
Practice Address - Country:US
Practice Address - Phone:770-888-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant