Healthcare Provider Details

I. General information

NPI: 1174276489
Provider Name (Legal Business Name): ARDEN MARIE TOMASSETTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 RALPH MCGILL BLVD NE APT 3301
ATLANTA GA
30312-1160
US

IV. Provider business mailing address

660 RALPH MCGILL BLVD NE APT 3301
ATLANTA GA
30312-1160
US

V. Phone/Fax

Practice location:
  • Phone: 860-304-5532
  • Fax:
Mailing address:
  • Phone: 860-304-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10826
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10826
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10826
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: