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1740294560

NPI Code Detail

MEDICARE: WENDY ANITA ROYAL PA

MEDICARE: WENDY ANITA ROYAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004813	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	511I970299	OTHER	GA	MEDICARE PIN QC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10058150	OTHER	GA	AMERIGROUP
3	343820	OTHER	GA	WELLCARE
4	341310	OTHER	GA	WELLCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	343819	OTHER	GA	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	343821	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1740294560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ANITA ROYAL PA

Provider Business Mailing Address
First Line	:	601 S ENOTA DR NE
Second Line	:	STE Q
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2400
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:	770-219-8440

Provider Business Practice Location Address
First Line	:	4919 ATLANTA HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3328
Country	:	US
Telephone Number	:	770-965-9222
Fax Number	:	770-965-8811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/19/2010

Similar Medicare Providers

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Practice Location Address:

4919 ATLANTA HWY
FLOWERY BRANCH, GA
30542-3328

Practice Phone: 770-965-9222
Practice Fax: 770-965-8811

1689641508 — CARLA P. WHITLOW PA
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1407119753 — JULIE MONTGOMERY SMITH PA
Practice Location Address:

4919 ATLANTA HWY
FLOWERY BRANCH, GA
30542-3328

Practice Phone: 770-965-9222
Practice Fax: 770-965-8811

1730437732 — MEREDITH L. FOX PA-C
Practice Location Address:

4919 ATLANTA HWY
FLOWERY BRANCH, GA
30542-3328

Practice Phone: 770-848-9160
Practice Fax:

1518457449 — SHAAKIRA A FORD LCSW
Practice Location Address:

4919 ATLANTA HWY
FLOWERY BRANCH, GA
30542-3328

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1891258471 — ERIK RODRIGUEZ
Practice Location Address:

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Directions to “ WENDY ANITA ROYAL PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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