Provider Demographics
NPI:1679512214
Name:TURNER, JOHN WESLEY (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:TURNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2535
Mailing Address - Country:US
Mailing Address - Phone:770-771-5570
Mailing Address - Fax:678-344-8600
Practice Address - Street 1:5013 CAGLE MILL RD
Practice Address - Street 2:
Practice Address - City:LULA
Practice Address - State:GA
Practice Address - Zip Code:30554-2727
Practice Address - Country:US
Practice Address - Phone:770-869-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS50164Medicare UPIN