MEDICARE: MRS. ANGELA WINN EWING 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	003489	GA

General Provider Information

NPI Number	:	1801885942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA WINN EWING PA-C

Provider Business Mailing Address
First Line	:	PO BOX 12938
Second Line	:	C/O CLINIC MANAGEMENT
City	:	CALHOUN
State	:	GA
Zip	:	30703
Country	:	US
Telephone Number	:	706-602-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 JOHN MADDOX DR NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1413
Country	:	US
Telephone Number	:	706-368-8550
Fax Number	:	706-236-7473

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/16/2024

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