Healthcare Provider Details

I. General information

NPI: 1982255303
Provider Name (Legal Business Name): NATHAN SCOTT WEHTJE PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

470 NORTHSIDE CHEROKEE BLVD STE 480
CANTON GA
30115-8034
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone: 404-962-6000
  • Fax: 404-962-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10260
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: