Provider Demographics
NPI:1700508082
Name:AUGUST, ALYSIA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:MARIE
Last Name:AUGUST
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 1:1549 HIGH HAVEN CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3203
Mailing Address - Country:US
Mailing Address - Phone:404-698-8575
Mailing Address - Fax:
Practice Address - Street 1:3131 MAPLE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2515
Practice Address - Country:US
Practice Address - Phone:404-816-7900
Practice Address - Fax:404-816-7929
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant