Provider Demographics
NPI:1669200192
Name:ROSALES MEJIA, SHIRLEY (PA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ROSALES MEJIA
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 1:3905 JOHNS CREEK CT STE 200
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1225
Mailing Address - Country:US
Mailing Address - Phone:770-495-0799
Mailing Address - Fax:770-495-0783
Practice Address - Street 1:3905 JOHNS CREEK CT STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1225
Practice Address - Country:US
Practice Address - Phone:770-495-0799
Practice Address - Fax:770-495-0783
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPENDING208C00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery