Healthcare Provider Details

I. General information

NPI: 1487629440
Provider Name (Legal Business Name): GINA THERESA ATCHISON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 OAKWOOD AVE
OAKWOOD OH
45419-2911
US

IV. Provider business mailing address

1110 OAKWOOD AVE
OAKWOOD OH
45419-2911
US

V. Phone/Fax

Practice location:
  • Phone: 937-885-7163
  • Fax: 937-567-0670
Mailing address:
  • Phone: 937-885-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50-00-1815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: