Provider Demographics
NPI:1801885942
Name:EWING, ANGELA WINN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:WINN
Last Name:EWING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:15 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-368-8550
Practice Address - Fax:706-236-7473
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06587Medicare UPIN
GA97BBFTTMedicare ID - Type Unspecified
GA97BBFTTMedicare ID - Type Unspecified