Provider Demographics
NPI:1962845867
Name:SKEELING, ALEX (CSA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:SKEELING
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391892
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0032
Mailing Address - Country:US
Mailing Address - Phone:678-662-8544
Mailing Address - Fax:
Practice Address - Street 1:2300 COUNTRY WALK APT 523
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7921
Practice Address - Country:US
Practice Address - Phone:678-662-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4072363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical