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NPI Code Detail

MEDICARE: WESLEY RYAN ALLEN

MEDICARE: WESLEY RYAN ALLEN
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 Assistant

General Provider Information

NPI Number : 1902629611
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY RYAN ALLEN
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 : 2600 CENTURY PKWY NE
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3125
Country : US
Telephone Number : 404-282-3632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2024
Last Update Date : 12/13/2025

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Directions to “ WESLEY RYAN ALLEN ” Practice Location

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