Provider Demographics
NPI:1598320087
Name:DOWNS, EMILY REBECCA (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:DOWNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 DEPUTY BILL CANTRELL MEMORIAL ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-781-8004
Mailing Address - Fax:678-678-4053
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEMORIAL ROAD STE 150
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-781-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9300363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1162357OtherNCCPA
GA9300OtherGA STATE LICENSE