Healthcare Provider Details

I. General information

NPI: 1306575899
Provider Name (Legal Business Name): HILARY ELISE GARREAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 WILLEO RD STE 206
ROSWELL GA
30075-6773
US

IV. Provider business mailing address

3524 WINDRIDGE DR
MARIETTA GA
30066-2657
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-1520
  • Fax: 770-999-2673
Mailing address:
  • Phone: 404-547-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: