Provider Demographics
NPI:1841793817
Name:ANTHONY, ROXANNE CAMILLE EDWARDS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:CAMILLE EDWARDS
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4223 PERIMETER PARK E
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1366
Mailing Address - Country:US
Mailing Address - Phone:404-944-8013
Mailing Address - Fax:
Practice Address - Street 1:61 WHITCHER ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5055
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X, 363AM0700X
GA8709363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical