Healthcare Provider Details

I. General information

NPI: 1396412110
Provider Name (Legal Business Name): ALEJANDRA ESCAMILLA MARTINEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DAWSON VILLAGE WAY S
DAWSONVILLE GA
30534-5629
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4360
  • Fax: 470-251-6066
Mailing address:
  • Phone: 770-914-0116
  • Fax: 770-955-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: