MEDICARE: ANNA BEACH 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	50.009870RX	OH

General Provider Information

NPI Number	:	1871244756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA BEACH PA-C

Provider Business Mailing Address
First Line	:	PO BOX 947977
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7977
Country	:	US
Telephone Number	:	561-948-0291
Fax Number	:	561-859-0429

Provider Business Practice Location Address
First Line	:	150 TAYLOR STATION RD STE 250
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4440
Country	:	US
Telephone Number	:	614-863-3222
Fax Number	:	614-863-4440

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	04/20/2026

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Directions to “ ANNA BEACH PA-C” Practice Location

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