Provider Demographics
NPI:1326739764
Name:REDDEN, ASTIN ALYSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASTIN
Middle Name:ALYSE
Last Name:REDDEN
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 1:47 CHEROKEE FAIRWAYS
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-4355
Mailing Address - Country:US
Mailing Address - Phone:770-324-4670
Mailing Address - Fax:
Practice Address - Street 1:3240 NORTHEAST EXPY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4003
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11568363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical