Provider Demographics
NPI:1023742921
Name:WORTHAM, PASSION (MEDICAL ASSISTANT-MA)
Entity type:Individual
Prefix:
First Name:PASSION
Middle Name:
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 IVY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2234
Mailing Address - Country:US
Mailing Address - Phone:404-477-9199
Mailing Address - Fax:
Practice Address - Street 1:6603 CHURCH ST APT D4
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2204
Practice Address - Country:US
Practice Address - Phone:404-477-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant