Provider Demographics
NPI:1447474663
Name:WAKEMAN, HANS DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:DOUGLAS
Last Name:WAKEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 E SHADOWLAWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2405
Mailing Address - Country:US
Mailing Address - Phone:404-364-0900
Mailing Address - Fax:404-364-9030
Practice Address - Street 1:3121 E SHADOWLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2405
Practice Address - Country:US
Practice Address - Phone:404-364-0900
Practice Address - Fax:404-364-9030
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDBPMedicare ID - Type Unspecified