Individual
MR. BRUCE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11766 HIGHWAY 27, SUITE A, SUMMERVILLE, GA 30747-5989
(706) 734-2878
(706) 734-2877
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001146
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126932A
—
GA
Enumeration date
08/30/2006
Last updated
05/07/2020
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