Provider Demographics
NPI:1619038932
Name:CARUSO, ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CARUSO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:95 COLLIER ROAD NW
Mailing Address - Street 2:SUITE 2035
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:95 COLLIER ROAD NW
Practice Address - Street 2:SUITE 2035
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004241363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA608997087DEMedicaid
GA202I979769Medicare PIN
P47036Medicare UPIN