Healthcare Provider Details

I. General information

NPI: 1225514201
Provider Name (Legal Business Name): DANICA LEIGH PINSON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 370
MARIETTA GA
30068-4396
US

IV. Provider business mailing address

4800 OLDE TOWNE PKWY STE 370
MARIETTA GA
30068-4396
US

V. Phone/Fax

Practice location:
  • Phone: 678-631-4620
  • Fax: 678-631-4621
Mailing address:
  • Phone: 678-631-4620
  • Fax: 678-631-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: