Provider Demographics
NPI:1780457549
Name:WENZELL, PATRICK CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:WENZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2720
Mailing Address - Country:US
Mailing Address - Phone:678-640-6119
Mailing Address - Fax:
Practice Address - Street 1:14 NORTON AVE
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2720
Practice Address - Country:US
Practice Address - Phone:678-640-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057009484343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)