Provider Demographics
NPI:1417099870
Name:MAY, TWANYA J (PAC)
Entity Type:Individual
Prefix:
First Name:TWANYA
Middle Name:J
Last Name:MAY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TWANYA
Other - Middle Name:JO
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3727
Mailing Address - Fax:
Practice Address - Street 1:1500 OGLETHORPE AVE STE 400A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2182
Practice Address - Country:US
Practice Address - Phone:706-548-8600
Practice Address - Fax:706-548-1655
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23997Medicare UPIN