MEDICARE: STEVEN ALEXANDER MCRAE PA

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	5281	GA

General Provider Information

NPI Number	:	1689988842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ALEXANDER MCRAE PA

Provider Business Mailing Address
First Line	:	392 SPRING HILL DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-4259
Country	:	US
Telephone Number	:	770-823-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 DOWNWOOD CIR NW STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1659
Country	:	US
Telephone Number	:	404-352-4500
Fax Number	:	404-350-0722

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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