Healthcare Provider Details

I. General information

NPI: 1306442058
Provider Name (Legal Business Name): EMILY SPILLANE FIKSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ORTHO LN
ATLANTA GA
30329-2315
US

IV. Provider business mailing address

21 ORTHO LN
ATLANTA GA
30329-2315
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-3000
  • Fax:
Mailing address:
  • Phone: 404-251-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9984
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: