Provider Demographics
NPI:1467094052
Name:DEAL, NATALIE WYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:WYNN
Last Name:DEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RYAN
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4321 UNIVERSITY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3093
Mailing Address - Country:US
Mailing Address - Phone:706-854-2600
Mailing Address - Fax:
Practice Address - Street 1:4321 UNIVERSITY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3093
Practice Address - Country:US
Practice Address - Phone:706-854-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9502208000000X
GA9503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty