Healthcare Provider Details

I. General information

NPI: 1134452568
Provider Name (Legal Business Name): DEANA J PORTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E GLENN AVE
AUBURN AL
36830-5729
US

IV. Provider business mailing address

505 ARBOR LN
CENTERVILLE GA
31028-8613
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-0078
  • Fax: 334-528-0079
Mailing address:
  • Phone: 334-663-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: