Healthcare Provider Details

I. General information

NPI: 1679512214
Provider Name (Legal Business Name): JOHN WESLEY TURNER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5013 CAGLE MILL RD
LULA GA
30554-2727
US

IV. Provider business mailing address

2696 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2535
US

V. Phone/Fax

Practice location:
  • Phone: 770-869-9791
  • Fax:
Mailing address:
  • Phone: 770-771-5570
  • Fax: 678-344-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: