Provider Demographics
NPI:1336200708
Name:SICKLES, AMY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:SICKLES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-419-1140
Mailing Address - Fax:404-419-1164
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 4600
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7658
Practice Address - Country:US
Practice Address - Phone:770-205-5292
Practice Address - Fax:770-205-5291
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-11-08
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Provider Licenses
StateLicense IDTaxonomies
GA005070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
GA1336200708Medicare UPIN