MEDICARE: MONICA CHRISTINE PO 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	2860	SC
2	363A00000X	Physician Assistant	9218	GA

General Provider Information

NPI Number	:	1932612082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA CHRISTINE PO PA-C

Provider Business Mailing Address
First Line	:	3850 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4807
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:	678-205-5111

Provider Business Practice Location Address
First Line	:	3331 HAMILTON MILL RD STE 1106
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-7226
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:	678-205-5111

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

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	08/25/2023

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Directions to “ MONICA CHRISTINE PO PA-C” Practice Location

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