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NPI Code Detail

MEDICARE: MRS. FELICITY A DEVAUGHN PA-C

MEDICARE: MRS. FELICITY A DEVAUGHN 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
1363AM0700XMedical Physician Assistant1294TN

General Provider Information

NPI Number : 1568593788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. FELICITY A DEVAUGHN PA-C
Provider Business Mailing Address
First Line : 711 CANTON RD NE
Second Line : STE 220
City : MARIETTA
State : GA
Zip : 30060-8949
Country : US
Telephone Number : 615-791-4790
Fax Number : 615-791-4531
Provider Business Practice Location Address
First Line : 790 CHURCH ST NE STE 510
Second Line :
City : MARIETTA
State : GA
Zip : 30060-8957
Country : US
Telephone Number : 404-554-2196
Fax Number : 615-791-4531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 03/12/2019

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Directions to “ MRS. FELICITY A DEVAUGHN PA-C” Practice Location

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