Provider Demographics
NPI:1396412110
Name:ESCAMILLA MARTINEZ, ALEJANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:ESCAMILLA MARTINEZ
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 1:5705 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3943
Mailing Address - Country:US
Mailing Address - Phone:470-387-1507
Mailing Address - Fax:
Practice Address - Street 1:5705 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3943
Practice Address - Country:US
Practice Address - Phone:470-387-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA11652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program