Provider Demographics
NPI:1659132256
Name:ACKERMAN, SKYLAR COPPINGER (PA-C)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:COPPINGER
Last Name:ACKERMAN
Suffix:
Gender:F
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 1:2285 ASQUITH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-6092
Mailing Address - Country:US
Mailing Address - Phone:770-485-1554
Mailing Address - Fax:770-783-6775
Practice Address - Street 1:2285 ASQUITH AVE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-6092
Practice Address - Country:US
Practice Address - Phone:770-485-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant