MEDICARE: KAIA LOWE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004319	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004319	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1518024694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIA LOWE PA

Provider Business Mailing Address
First Line	:	6572 RIVER PARK DR
Second Line	:	#101
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2214
Country	:	US
Telephone Number	:	770-996-6699
Fax Number	:	770-692-2669

Provider Business Practice Location Address
First Line	:	6572 RIVER PARK DR
Second Line	:	#101
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2214
Country	:	US
Telephone Number	:	770-996-6699
Fax Number	:	770-692-2669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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Directions to “ KAIA LOWE PA” Practice Location

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