Allison Nicole Anderson, P.A-C
Individual provider Active NPI Physician Assistant · Lawrenceville, GA
NPI 1639124233 · NPPES record last updated Aug 23, 2007
Key facts
- NPI
- 1639124233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 004750 (GA)
- Practice address
- 1000 Medical Center Blvd
Lawrenceville, GA 30045-7694 - Phone
- (678) 442-3317
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210414002861 | UT | Practitioner - Physician Assistant | 1658376009 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004750 | GA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004750 | GA | Yes |
Addresses
Primary practice location
1000 Medical Center Blvd
Lawrenceville, GA 30045-7694
Mailing address
1000 Medical Center Blvd
Lawrenceville, GA 30045-7694
Other providers in Lawrenceville, GA
- Beatriz Albuquerque Amorim
- Kwasi K. Ampomah
- Amy Profesorsky
- Jong An
- Mone Ancrum
- Amy Anderson
- Blessing Adeagbo Anderson
- Dana Anderson
- David Nelson Anderson
- Destiny Anderson
All providers in Lawrenceville, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.