MEDICARE: MARY ALEXANDER-ADAMS 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	4330	GA

General Provider Information

NPI Number	:	1831312081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ALEXANDER-ADAMS PA-C

Provider Business Mailing Address
First Line	:	705 DALLAS HWY STE 101
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1243
Country	:	US
Telephone Number	:	770-459-4411
Fax Number	:	770-459-1895

Provider Business Practice Location Address
First Line	:	705 DALLAS HWY STE 101
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1243
Country	:	US
Telephone Number	:	770-459-4411
Fax Number	:	770-459-1895

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	06/23/2010

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Directions to “ MARY ALEXANDER-ADAMS PA-C” Practice Location

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