Provider Demographics
NPI:1902871403
Name:DUBNER, WAYNE J (DPM)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:DUBNER
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:770-432-7638
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-237-3668
Practice Address - Fax:404-237-9562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD000718213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU19135Medicare UPIN
GA48SCBMKMedicare ID - Type Unspecified