Active NPI
Adrienne Disisto, PA-C
- Physician Assistant
- Atlanta, GA
National Provider Identifier
1104190206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006379
- Practice address
- 764 Greenwood Ave NE
Atlanta, GA 30306-3721 - Phone
- (917) 326-0670
- NPI assigned
- Mar 7, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006379 | GA | Primary |
Addresses
Primary practice location
764 Greenwood Ave NE
Atlanta, GA 30306-3721
Mailing address
764 Greenwood Ave NE
Atlanta, GA 30306-3721
Phone (917) 326-0670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006379 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331078400000",
"number": "1104190206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "764 GREENWOOD AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303063721",
"telephone_number": "917-326-0670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "764 GREENWOOD AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303063721",
"telephone_number": "917-326-0670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISISTO",
"first_name": "ADRIENNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-07",
"last_updated": "2012-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "006379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
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- Discovery Practice Management, Inc.
- Discovery Therapy Network
- Lindsey L Diskin, CRNA
- Abegail Tate Dismukes
- Dispatchhealth Advanced Care LLC
- Franco Dispenza, PHD
- Geertruida Cornelia Disseldorp, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.