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NPI Code Detail

MEDICARE: MR. MARK WESCOTT MPAS,PA-C

MEDICARE: MR. MARK WESCOTT MPAS,PA-C
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
1363AM0700XMedical Physician Assistant7803GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17803OTHERGAGEORGIA COMPOSITE MEDICAL BOARD

General Provider Information

NPI Number : 1821310442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK WESCOTT MPAS,PA-C
Provider Business Mailing Address
First Line : 6024 STORY MILL RD
Second Line :
City : KEYSVILLE
State : GA
Zip : 30816-4532
Country : US
Telephone Number : 352-552-8828
Fax Number :
Provider Business Practice Location Address
First Line : 3485 MIKE PADGETT HWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-3815
Country : US
Telephone Number : 706-771-9321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2010
Last Update Date : 03/08/2026

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