MEDICARE: MRS. MILISSA JOHNSON FITZGERALD PA-C, MS

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	102816	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00601913	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	102816	OTHER	NC	NC LISCENSURE

General Provider Information

NPI Number	:	1043361108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MILISSA JOHNSON FITZGERALD PA-C, MS

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-759-0700
Fax Number	:	336-759-2226

Provider Business Practice Location Address
First Line	:	7811 N POINT BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3209
Country	:	US
Telephone Number	:	336-759-0700
Fax Number	:	336-759-2226

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/14/2013

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