MEDICARE: MS. LEITH AUDREY FITCH PA-C

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	03201	GA

General Provider Information

NPI Number	:	1821284027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEITH AUDREY FITCH PA-C

Provider Business Mailing Address
First Line	:	118 HURT DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2702
Country	:	US
Telephone Number	:	404-281-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 HURT DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2702
Country	:	US
Telephone Number	:	404-281-0995
Fax Number	:

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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