Provider Demographics
NPI:1578348017
Name:AUTRY, ANNALEIGH GRACE
Entity Type:Individual
Prefix:
First Name:ANNALEIGH
Middle Name:GRACE
Last Name:AUTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 KEENELAND CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5420
Mailing Address - Country:US
Mailing Address - Phone:770-733-4700
Mailing Address - Fax:
Practice Address - Street 1:4019 KEENELAND CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5420
Practice Address - Country:US
Practice Address - Phone:770-733-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant