Healthcare Provider Details

I. General information

NPI: 1134875206
Provider Name (Legal Business Name): ALMIR AGIC PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHERRY ST NE
MARIETTA GA
30060-7205
US

IV. Provider business mailing address

221 QUAIL RUN
ROSWELL GA
30076-3110
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5700
  • Fax:
Mailing address:
  • Phone: 678-343-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: