Provider Demographics
NPI:1558493619
Name:PRICE, LETITIA W (PA)
Entity Type:Individual
Prefix:MISS
First Name:LETITIA
Middle Name:W
Last Name:PRICE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:132 OLD NORTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4872
Practice Address - Country:US
Practice Address - Phone:678-817-1117
Practice Address - Fax:678-817-0823
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-01-13
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Provider Licenses
StateLicense IDTaxonomies
GA005009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACA9328OtherMEDICARE GROUP-DMERC
GA747792658AMedicaid
GAQ77036Medicare UPIN
GA202I972223Medicare PIN