Healthcare Provider Details

I. General information

NPI: 1477572873
Provider Name (Legal Business Name): JOHN WESLEY ATKINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 ALAMEDA AVE
FIRCREST WA
98466-6552
US

IV. Provider business mailing address

1339 ALAMEDA AVE
FIRCREST WA
98466-6552
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-7701
  • Fax: 253-566-4688
Mailing address:
  • Phone: 253-564-7701
  • Fax: 253-566-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0013874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: