Provider Demographics
NPI:1134188105
Name:TOUSSAINT, EDDY (PA-C)
Entity type:Individual
Prefix:MR
First Name:EDDY
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:M
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 1:980 JOHNSON FERRY RD
Mailing Address - Street 2:STE 1040
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:770-292-3460
Mailing Address - Fax:404-300-2317
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8017
Practice Address - Country:US
Practice Address - Phone:770-292-3490
Practice Address - Fax:770-721-5615
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004561363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA505981429EMedicaid
GA505981429IMedicaid
GA505981429KMedicaid
GA505981429BMedicaid
GA505981429CMedicaid
GA505981429JMedicaid
GA505981429FMedicaid
GA505981429DMedicaid
GA505981429BMedicaid
GA505981429JMedicaid