Provider Demographics
NPI:1295791408
Name:DOALLAS, CYNTHIA ANN (PA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:DOALLAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1780
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-927-0267
Practice Address - Street 1:900 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1780
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-927-0267
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003750363A00000X, 207N00000X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA451661273BMedicaid
GA451661273AMedicaid
GA451661273CMedicaid
GA100002291AMedicaid
GA970025786OtherRAILROAD MEDICARE NUMBER
GA970025786OtherRAILROAD MEDICARE NUMBER
GA451661273CMedicaid