Provider Demographics
NPI:1962553719
Name:MESSICK, RYAN LEE (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:MESSICK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 STONEFOREST DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4881
Mailing Address - Country:US
Mailing Address - Phone:770-423-0595
Mailing Address - Fax:678-388-1627
Practice Address - Street 1:61 WHITCHER STREET NE
Practice Address - Street 2:SUITE 2100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5093
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004464363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA703847178BMedicaid
GAQ40150Medicare UPIN
GA703847178BMedicaid