Provider Demographics
NPI:1639136161
Name:JEFFERS, ANTOINETTE Y L (MMSC, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:Y L
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5478 SPELMAN DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8093
Mailing Address - Country:US
Mailing Address - Phone:404-298-7586
Mailing Address - Fax:
Practice Address - Street 1:2885 HEADLAND DR
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6652
Practice Address - Country:US
Practice Address - Phone:404-344-9333
Practice Address - Fax:404-344-9922
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA901687708CMedicaid