Provider Demographics
NPI:1174276489
Name:TOMASSETTI, ARDEN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ARDEN
Middle Name:MARIE
Last Name:TOMASSETTI
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 1:660 RALPH MCGILL BLVD NE APT 3301
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1160
Mailing Address - Country:US
Mailing Address - Phone:860-304-5532
Mailing Address - Fax:
Practice Address - Street 1:660 RALPH MCGILL BLVD NE APT 3301
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1160
Practice Address - Country:US
Practice Address - Phone:860-304-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10826363AM0700X, 363A00000X, 207P00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine