Provider Demographics
NPI:1790031011
Name:SALMON, ARLENE L (PA)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:L
Last Name:SALMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1838 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6611
Mailing Address - Country:US
Mailing Address - Phone:770-995-7622
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:4855 RIVER GREEN PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8336
Practice Address - Country:US
Practice Address - Phone:770-622-0880
Practice Address - Fax:770-622-9875
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6497363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126736AMedicaid
GA202I979508Medicare PIN