Healthcare Provider Details

I. General information

NPI: 1619943230
Provider Name (Legal Business Name): PAGETT LOUISE BOSSI P. A. - C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

124 PINEHURST ST
DECATUR GA
30030-2734
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-7630
  • Fax:
Mailing address:
  • Phone: 404-687-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: