Provider Demographics
NPI:1992750350
Name:WAUGH, LYNDON D (MD)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:D
Last Name:WAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LYNDON
Other - Middle Name:DALE
Other - Last Name:WAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7000 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:BLDG 16 SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-393-1880
Mailing Address - Fax:770-393-1885
Practice Address - Street 1:7000 PEACHTREE DUNWOODY RD
Practice Address - Street 2:BLDG 16 SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-393-1880
Practice Address - Fax:770-393-1885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0176572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31254Medicare UPIN