Provider Demographics
NPI:1184692790
Name:ENSLEY, WESLEY DON (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:DON
Last Name:ENSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 TOWNE CENTER BLVD BLDG 1200
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4129
Mailing Address - Country:US
Mailing Address - Phone:912-748-2280
Mailing Address - Fax:912-748-4988
Practice Address - Street 1:1000 TOWNE CENTER BLVD BLDG 1200
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4129
Practice Address - Country:US
Practice Address - Phone:912-748-2280
Practice Address - Fax:912-748-4988
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01139727OtherRAILROAD MEDICARE
GA000801765DMedicaid
GAG80074Medicare UPIN
GA202I083879Medicare PIN