Provider Demographics
NPI:1043549702
Name:DUNCAN, PATRICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CROSSTOWN RD # 141
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2948
Mailing Address - Country:US
Mailing Address - Phone:678-777-0158
Mailing Address - Fax:770-486-8007
Practice Address - Street 1:312 CROSSTOWN RD # 141
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2948
Practice Address - Country:US
Practice Address - Phone:678-777-0158
Practice Address - Fax:770-486-8007
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004703363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA125000263BMedicaid