MEDICARE: ALICIA TOUBIANA 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	5750	GA
2	363AM0700X	Medical Physician Assistant
3	363A00000X	Physician Assistant	5753	GA

General Provider Information

NPI Number	:	1215265681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA TOUBIANA PA-C

Provider Business Mailing Address
First Line	:	1700 HOSPITAL SOUTH DR STE 409
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-8159
Country	:	US
Telephone Number	:	770-732-9100
Fax Number	:	770-528-9924

Provider Business Practice Location Address
First Line	:	1700 HOSPITAL SOUTH DR STE 409
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-8159
Country	:	US
Telephone Number	:	770-732-9100
Fax Number	:

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	08/27/2020

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