Provider Demographics
NPI:1689669210
Name:SNIPES, STEVEN A (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:SNIPES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 OSLER CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0205
Mailing Address - Country:US
Mailing Address - Phone:229-883-1503
Mailing Address - Fax:229-438-9534
Practice Address - Street 1:2400 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-883-1503
Practice Address - Fax:229-438-9534
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20820363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002036AMedicaid
P24272Medicare UPIN
GA97WCCQMMedicare PIN