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NPI Code Detail

MEDICARE: WESLEY GREEN PHYSICIAN ASSISTANT

MEDICARE: WESLEY GREEN PHYSICIAN ASSISTANT
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
1363A00000XPhysician Assistant
2363A00000XPhysician AssistantPA17169TX

General Provider Information

NPI Number : 1881473635
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY GREEN PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : PO BOX 749495
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9495
Country : US
Telephone Number : 855-963-2100
Fax Number : 813-321-1296
Provider Business Practice Location Address
First Line : 6621 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2358
Country : US
Telephone Number : 832-824-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2023
Last Update Date : 01/06/2026

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Directions to “ WESLEY GREEN PHYSICIAN ASSISTANT” Practice Location

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