MEDICARE: EMILY JULIETTE GAINES 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	363AM0700X	Medical Physician Assistant	10871	GA

General Provider Information

NPI Number	:	1528713716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JULIETTE GAINES PA-C

Provider Business Mailing Address
First Line	:	3194 BUFORD HWY
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3386
Country	:	US
Telephone Number	:	470-649-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	3194 BUFORD HWY
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3386
Country	:	US
Telephone Number	:	470-649-3902
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	06/07/2022

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