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General NPI Number Information
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NPI Number | 1437595501
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Entity Type | Individual
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Provider Name | LISSETTE MARIA ESTEVEZ VALDES MMSC, PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 4500 NORTH SHALLOWFORD ROAD EMORY FAMILY MEDICINE CLINIC
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City | ATLANTA
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State | GA
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Zip | 30338
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Country | US
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Telephone | 404-778-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 1462 CLIFTON ROAD, N.E., SUITE 280 EMORY UNIVERSITY PHYSICIAN ASSISTANT PROGRAM
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City | ATLANTA
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State | GA
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Zip | 30322
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Country | US
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Telephone | 404-727-2581
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Fax |
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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 | 003267
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License Number State | GA
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