Provider Demographics
NPI:1669592093
Name:DESSART, PAUL D (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:DESSART
Suffix:
Gender:M
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 1:5737 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1105
Mailing Address - Country:US
Mailing Address - Phone:478-471-0022
Mailing Address - Fax:
Practice Address - Street 1:306 CORDER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3606
Practice Address - Country:US
Practice Address - Phone:478-329-0291
Practice Address - Fax:478-329-1579
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002411363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical