Provider Demographics
NPI:1568593788
Name:DEVAUGHN, FELICITY A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:FELICITY
Middle Name:A
Last Name:DEVAUGHN
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 1:711 CANTON RD NE
Mailing Address - Street 2:STE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8949
Mailing Address - Country:US
Mailing Address - Phone:615-791-4790
Mailing Address - Fax:615-791-4531
Practice Address - Street 1:790 CHURCH ST NE STE 510
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8957
Practice Address - Country:US
Practice Address - Phone:404-554-2196
Practice Address - Fax:615-791-4531
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1294363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3664090Medicare PIN
TNQ60847Medicare UPIN