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General NPI Number Information
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NPI Number | 1164666962
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Entity Type | Individual
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Provider Name | CLARISSA ISABELLE GILES PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1611 SANDS PLACE STE 100
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-944-8042
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Fax | 678-293-7579
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Provider Business Mailing Address
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Address Line | 1611 SANDS PLACE STE 100
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-944-8042
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Fax | 678-293-7579
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9104959
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9104959
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8648
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 8648
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License Number State | GA
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