Provider Demographics
NPI:1750627279
Name:DEAR, MAGGIE LOUISE (PA)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:LOUISE
Last Name:DEAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:60 HIGHLAND CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-6773
Mailing Address - Country:US
Mailing Address - Phone:706-698-6400
Mailing Address - Fax:706-698-6401
Practice Address - Street 1:60 HIGHLAND CT
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6773
Practice Address - Country:US
Practice Address - Phone:706-698-6400
Practice Address - Fax:706-698-6401
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6643363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical