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Individual

DR. FADY S WANNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4300 W MAIN ST STE 21, DOTHAN, AL 36305-1058
(205) 620-7523
(205) 620-8667
Mailing address
PO BOX 6599, DOTHAN, AL 36302-6599
(205) 620-7523

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
37777
AL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
43813
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
51616
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000876895A
GA
01
511I330005
MEDICARE
05
PENDING
KY
Enumeration date
01/16/2006
Last updated
08/29/2024
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