Healthcare Provider Details

I. General information

NPI: 1326049461
Provider Name (Legal Business Name): JOHN WESLEY STRAIN II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 OAK LEAF DR SW
CARTERSVILLE GA
30120-5308
US

IV. Provider business mailing address

17 COLLINS DR
CARTERSVILLE GA
30120-2487
US

V. Phone/Fax

Practice location:
  • Phone: 706-604-9639
  • Fax:
Mailing address:
  • Phone: 706-604-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3234
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: