MEDICARE: KAYCE SALA CINCAR 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	9210	GA

General Provider Information

NPI Number	:	1508422551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCE SALA CINCAR PA-C

Provider Business Mailing Address
First Line	:	5922 REDWINE ST
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-1903
Country	:	US
Telephone Number	:	404-314-0509
Fax Number	:	404-303-9798

Provider Business Practice Location Address
First Line	:	975 JOHNSON FERRY RD STE 120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1618
Country	:	US
Telephone Number	:	770-355-1399
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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