Healthcare Provider Details

I. General information

NPI: 1568593788
Provider Name (Legal Business Name): FELICITY A DEVAUGHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 DALLAS HWY STE 107
POWDER SPRINGS GA
30127-6458
US

IV. Provider business mailing address

711 CANTON RD NE STE 220
MARIETTA GA
30060-8949
US

V. Phone/Fax

Practice location:
  • Phone: 678-833-1444
  • Fax: 678-833-1445
Mailing address:
  • Phone: 615-791-4790
  • Fax: 615-791-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8121
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1294
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: