Healthcare Provider Details

I. General information

NPI: 1275442576
Provider Name (Legal Business Name): PEYTON WESSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ROSS CLARK CIR
DOTHAN AL
36301-4754
US

IV. Provider business mailing address

458 OLD CAMPBELLTON HWY
MIDLAND CITY AL
36350
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: