Provider Demographics
NPI:1578778387
Name:NEITA, ANDREA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:NEITA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 MILGEN RD
Mailing Address - Street 2:SUITE 8761
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7849
Mailing Address - Country:US
Mailing Address - Phone:706-489-0858
Mailing Address - Fax:
Practice Address - Street 1:1073 WOODLAND HWY STE B
Practice Address - Street 2:
Practice Address - City:TALBOTTON
Practice Address - State:GA
Practice Address - Zip Code:31827-4549
Practice Address - Country:US
Practice Address - Phone:706-489-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA870227171AMedicaid
GA870227171AMedicaid
GAO8CBCPTMedicare UPIN