Individual
KENNETH DALE WENSLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12389 CRABAPPLE RD, ALPHARETTA, GA 30004-6328
(470) 299-1998
(470) 299-1898
Mailing address
12389 CRABAPPLE RD, ALPHARETTA, GA 30004-6328
(470) 299-1998
(470) 299-1898
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002823
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002823
LICENSE NUMBER
GA
Enumeration date
11/09/2006
Last updated
12/28/2023
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