Provider Demographics
NPI:1003868175
Name:HOSFELD, MOLLIE N (PA)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:N
Last Name:HOSFELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MOLLIE
Other - Middle Name:N
Other - Last Name:HERZBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 240
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6017
Mailing Address - Country:US
Mailing Address - Phone:770-844-0877
Mailing Address - Fax:770-844-0891
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 240
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6017
Practice Address - Country:US
Practice Address - Phone:770-844-0877
Practice Address - Fax:770-844-0891
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004448363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11051OtherBLUE CROSS BLUE SHIELD
GA119046432BMedicaid
GA119046432CMedicaid
GA119046432Medicaid
GA333508OtherWELLCARE
GA10044976OtherAMERIGROUP
Q42697Medicare UPIN
GA119046432BMedicaid