Provider Demographics
NPI:1427367192
Name:KEY, JULIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MICHELLE
Last Name:KEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:MICHELLE
Other - Last Name:MATHISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 SLATE AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-8222
Mailing Address - Country:US
Mailing Address - Phone:706-550-3407
Mailing Address - Fax:
Practice Address - Street 1:1270 PRINCE AVENUE SUITE 103
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-546-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical