Provider Demographics
NPI:1427010099
Name:ROONEY, EWA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:MARIE
Last Name:ROONEY
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 1:371 E PACES FERRY RD NE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3291
Mailing Address - Country:US
Mailing Address - Phone:404-355-1919
Mailing Address - Fax:404-352-5669
Practice Address - Street 1:371 E PACES FERRY RD NE STE 900
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3291
Practice Address - Country:US
Practice Address - Phone:404-355-1919
Practice Address - Fax:404-352-5669
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ19826Medicare UPIN
GA97WCFQPMedicare ID - Type Unspecified