Individual
OLENA VANWONTERGHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 BAYNARD PARK, NEWNAN, GA 30265-6413
(770) 251-5253
Mailing address
304 CALGARY DR, PEACHTREE CITY, GA 30269-2747
(586) 350-6839
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
77323
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/23/2014
Last updated
07/25/2019
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