MEDICARE: ANNA LEIGH VONCK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	025874	NY
2	363A00000X	Physician Assistant	11341	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	025874	OTHER	NY	OFFICE OF THE PROFESSIONS LICENSURE/REGISTRATION NUMBER
2	1177899	OTHER		NCCPA CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1023619129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LEIGH VONCK PA-C

Provider Business Mailing Address
First Line	:	6300 HOSPITAL PKWY STE 100
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-1829
Country	:	US
Telephone Number	:	770-771-6591
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 HOSPITAL PKWY STE 100
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-1829
Country	:	US
Telephone Number	:	707-716-5917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	05/11/2023

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Directions to “ ANNA LEIGH VONCK PA-C” Practice Location

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