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NPI Code Detail

MEDICARE: WESLEY PACE

MEDICARE: WESLEY PACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician89328GA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1548795636
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY PACE
Provider Business Mailing Address
First Line : 4159 MILL ST NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2546
Country : US
Telephone Number : 770-786-1234
Fax Number :
Provider Business Practice Location Address
First Line : 4159 MILL ST NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2546
Country : US
Telephone Number : 770-786-1234
Fax Number : 770-385-0813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2017
Last Update Date : 08/08/2021

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Directions to “ WESLEY PACE ” Practice Location

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