Ethan Jacob Wajswol, MD (5/18/2020)
Urology in Canton, GA. Individual provider (NPI-1).
NPI number1366076945
StatusActive
Last updated in NPPESJun 26, 2025
Details
- NPI
- 1366076945
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ethan Jacob Wajswol
- Credential
- MD (5/18/2020)
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 24, 2020
- Certification date
- Jun 26, 2025
- Last updated
- Jun 26, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208800000X | Urology | 99892 | GA | Yes |
Practice location
470 Northside Cherokee Blvd Ste 201Canton, GA 30115-8029
Phone 770-720-7246 · Fax 770-720-4620
Mailing address
1930 Brannan RdMcDonough, GA 30253-4310
Phone 678-284-4040
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