Provider Demographics
NPI:1508980947
Name:PERRY, CHAD A (PA C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:PERRY
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:308 COLISEUM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3876
Mailing Address - Country:US
Mailing Address - Phone:478-742-2180
Mailing Address - Fax:478-745-2623
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3876
Practice Address - Country:US
Practice Address - Phone:478-742-2180
Practice Address - Fax:478-745-2623
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA4573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ79422Medicare UPIN
GA97WCJQXMedicare PIN