Provider Demographics
NPI:1558656496
Name:NORGAARD, AMY CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:NORGAARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:GEFFRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8018
Mailing Address - Country:US
Mailing Address - Phone:470-639-6250
Mailing Address - Fax:770-345-0712
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8018
Practice Address - Country:US
Practice Address - Phone:470-639-6250
Practice Address - Fax:770-345-0712
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11481363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNENROLLEDMedicaid