Provider Demographics
NPI:1922780477
Name:CHARLES, PRIYADARSHINI (PA-C)
Entity Type:Individual
Prefix:
First Name:PRIYADARSHINI
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1757
Mailing Address - Country:US
Mailing Address - Phone:404-252-5669
Mailing Address - Fax:404-252-9473
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 330
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1757
Practice Address - Country:US
Practice Address - Phone:404-252-5669
Practice Address - Fax:404-252-9473
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty