Provider Demographics
NPI:1750811691
Name:HARVEY, AMELIA MCCANE (PA)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:MCCANE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:AMELIA
Other - Middle Name:GRACE
Other - Last Name:MCCANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 ASHLYN RDG
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3947
Mailing Address - Country:US
Mailing Address - Phone:678-332-7026
Mailing Address - Fax:
Practice Address - Street 1:150 N PARK TRL STE B
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7372
Practice Address - Country:US
Practice Address - Phone:770-507-0909
Practice Address - Fax:770-507-1919
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8365207Q00000X, 208000000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics