MEDICARE: MRS. NANCY C MCINNIS 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	001704	GA

General Provider Information

NPI Number	:	1871585158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY C MCINNIS PA

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY NW STE 2-100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2809
Country	:	US
Telephone Number	:	404-663-6130
Fax Number	:	404-289-5362

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY NW STE 2-100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2809
Country	:	US
Telephone Number	:	404-663-6130
Fax Number	:	404-289-5362

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/28/2025

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