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NPI Code Detail

MEDICARE: WESLEY RYAN ALLEN PA-C

MEDICARE: WESLEY RYAN ALLEN PA-C
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
1363A00000XPhysician Assistant13757GA

General Provider Information

NPI Number : 1902629611
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY RYAN ALLEN PA-C
Provider Business Mailing Address
First Line : 994 TEXEL LN
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-2735
Country : US
Telephone Number : 706-564-5773
Fax Number :
Provider Business Practice Location Address
First Line : 2174 N DRUID HILLS RD NE FL 1
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3102
Country : US
Telephone Number : 404-785-5437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2024
Last Update Date : 02/05/2026

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Directions to “ WESLEY RYAN ALLEN PA-C” Practice Location

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