Wallentine, Ryan C.

Wallentine, Ryan C. is an individual health care provider with primary practice located at 380 Hospital Dr Suite 410, Macon GA 31217. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as his primary health care specialty. Wallentine, Ryan C. can be contacted via phone (478) 746-5644.

Contact Information

Primary practice address
380 Hospital Dr Suite 410 Macon GA 31217
Phone: (478) 746-5644
Fax: (478) 745-4849
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X Georgia
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 006279 Georgia

Profile Details

NPI number 1114209525
LBN Legal business name Wallentine, Ryan C.
Credentials PA-AA
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 12th, 2011
Last updated Jun 4th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114209525 NPPES
Georgia Other 580628385 TRICARE
Georgia Other P01003812 TRICARE
Georgia MEDICAID 003114063C TRICARE
Georgia MEDICAID 003114063D TRICARE
Georgia MEDICAID 003114063B TRICARE
Georgia MEDICAID 003114063A TRICARE
Georgia Other 635417 TRICARE

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