Provider Demographics
NPI:1831485861
Name:ANTHONY, TELITA (CSA)
Entity Type:Individual
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First Name:TELITA
Middle Name:
Last Name:ANTHONY
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Gender:F
Credentials:CSA
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Mailing Address - Street 1:3649 BANCROFT MAIN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6012
Mailing Address - Country:US
Mailing Address - Phone:770-905-3089
Mailing Address - Fax:770-675-3716
Practice Address - Street 1:3649 BANCROFT MAIN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6012
Practice Address - Country:US
Practice Address - Phone:770-905-3089
Practice Address - Fax:770-675-3716
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2014-04-03
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Provider Licenses
StateLicense IDTaxonomies
GA2898363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical