Healthcare Provider Details

I. General information

NPI: 1861280059
Provider Name (Legal Business Name): WESLEY HARRIS CHASTAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 HARPER ST
AUGUSTA GA
30912-0020
US

IV. Provider business mailing address

1004 CHAFEE AVE DEPARTMENT OF DERMATOLOGY
AUGUSTA GA
30904-5810
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6321
  • Fax:
Mailing address:
  • Phone: 706-721-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR81633
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number112248
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: