Provider Demographics
NPI:1649900143
Name:RILEY, CASSANDRA CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CATHERINE
Last Name:RILEY
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 1:7 EXECUTIVE PARK DR NE APT 1201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2261
Mailing Address - Country:US
Mailing Address - Phone:862-354-7916
Mailing Address - Fax:
Practice Address - Street 1:5239 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2671
Practice Address - Country:US
Practice Address - Phone:678-660-5106
Practice Address - Fax:678-660-5107
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 363A00000X
GA12041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program