Provider Demographics
NPI:1700849940
Name:WALSH, ALYSON MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:MARIE
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:70 FRANCIS ST, 5TH FL, CARDIOLOGY
Mailing Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL - SHAPIRO BLDG
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:857-307-1945
Mailing Address - Fax:857-307-2022
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-355-9815
Practice Address - Fax:404-350-0529
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA356064994BMedicaid
GA356064994AMedicaid
Q40111Medicare UPIN
GA356064994BMedicaid
GA97WCHQTMedicare PIN
GA356064994AMedicaid