Provider Demographics
NPI:1477090900
Name:FRITZ-INGALLS, RENEE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:FRITZ-INGALLS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1348 WALTON WAY STE 5700
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-8242
Practice Address - Fax:706-722-8351
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07002363AS0400X
GA009113363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical