Provider Demographics
NPI:1316937402
Name:RISLEY, RYAN (PA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:RISLEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:925 N POINT PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5211
Mailing Address - Country:US
Mailing Address - Phone:678-206-2589
Mailing Address - Fax:678-261-1713
Practice Address - Street 1:81 NORTHSIDE DAWSON DR STE 203
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-7164
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:678-347-2104
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant