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Individual

WENDY ANITA ROYAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
4919 ATLANTA HWY, FLOWERY BRANCH, GA 30542-3328
(770) 965-9222
(770) 965-8811
Mailing address
601 S ENOTA DR NE, STE Q, GAINESVILLE, GA 30501-2400
(770) 219-8420
(770) 219-8440

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004813
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000311737C
GA
05
000311737D
GA
05
000311737E
GA
01
10058150
AMERIGROUP
GA
01
341310
WELLCARE
GA
01
343819
WELLCARE
GA
01
343820
WELLCARE
GA
01
343821
WELLCARE
GA
01
511I970299
MEDICARE PIN QC
GA
05
748980904A
GA
05
748980904B
GA
05
748980904G
GA
Enumeration date
07/28/2006
Last updated
02/19/2010
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