Provider Demographics
NPI:1639395684
Name:MINK, KRISTIN C (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:C
Last Name:MINK
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 GENEVIEVE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4868
Mailing Address - Country:US
Mailing Address - Phone:770-486-1818
Mailing Address - Fax:770-486-7303
Practice Address - Street 1:100 GENEVIEVE CT
Practice Address - Street 2:SUITE A
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4868
Practice Address - Country:US
Practice Address - Phone:770-486-1818
Practice Address - Fax:770-486-7303
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA005047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I979595Medicare PIN