Provider Demographics
NPI:1518262450
Name:PALGON, ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PALGON
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 1:835 COGBURN AVE NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1031
Mailing Address - Country:US
Mailing Address - Phone:770-422-5557
Mailing Address - Fax:770-422-5456
Practice Address - Street 1:835 COGBURN AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1031
Practice Address - Country:US
Practice Address - Phone:770-422-5557
Practice Address - Fax:770-422-5456
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant