Provider Demographics
NPI:1265496186
Name:TROSSEVIN, NEIL A (PA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:TROSSEVIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2545
Mailing Address - Country:US
Mailing Address - Phone:770-538-7777
Mailing Address - Fax:770-538-7778
Practice Address - Street 1:597 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2545
Practice Address - Country:US
Practice Address - Phone:770-538-7777
Practice Address - Fax:770-538-7778
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002576BMedicaid
GA100002576AMedicaid
GAP34953Medicare UPIN
GA97WCJKLMedicare PIN
GA97WCCMVMedicare PIN