Provider Demographics
NPI:1972524270
Name:HULSEY, WAYNE G (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:G
Last Name:HULSEY
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:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0813
Mailing Address - Country:US
Mailing Address - Phone:770-267-7789
Mailing Address - Fax:770-267-7828
Practice Address - Street 1:333 ALCOVY ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:770-267-7789
Practice Address - Fax:770-267-7828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA142752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00054194CMedicaid
GAD29818Medicare UPIN
GA30BDCMDMedicare ID - Type Unspecified