Provider Demographics
NPI:1750760914
Name:LERMA, MARIA ALEJANDRA (PA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:LERMA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ALEJANDRA
Other - Last Name:EGUILUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:5959 HIGHWAY 53 E STE 100
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6288
Practice Address - Country:US
Practice Address - Phone:770-887-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant