MEDICARE: ANNE C AUDIER 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	01100010322	VA
2	363AM0700X	Medical Physician Assistant	9168	GA
3	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245795921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE C AUDIER PA-C

Provider Business Mailing Address
First Line	:	5665 NEW NORTHSIDE DR STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4617
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 NEW NORTHSIDE DR STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4617
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	01/13/2025

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Directions to “ ANNE C AUDIER PA-C” Practice Location

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