Healthcare Provider Details

I. General information

NPI: 1386824233
Provider Name (Legal Business Name): FELICIA LOREN HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA LOREN DENNIS PA-C

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 280
ROSWELL GA
30076-4918
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 280
ROSWELL GA
30076-4918
US

V. Phone/Fax

Practice location:
  • Phone: 770-754-0787
  • Fax: 770-755-5890
Mailing address:
  • Phone: 770-754-0787
  • Fax: 770-755-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: