Healthcare Provider Details

I. General information

NPI: 1780034595
Provider Name (Legal Business Name): WESLEY A ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23RD MEDICAL GROUP 3280 MITCHELL BLVD
MOODY AFB GA
31699-0001
US

IV. Provider business mailing address

3280 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-2778
  • Fax:
Mailing address:
  • Phone: 229-257-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30463
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: